Editorial: [Improving Our Health Care Deliver (Jose M. Belizan)]

Advances in fertility are a major achievement in our specialty which required the joint activities of basic and clinical researchers. We have now something to offer to unfertile couples. However, assisted fertilization is associated with an increase risk of adverse perinatal outcomes. An important advancement to reduce such adverse outcomes is the single embryo transfer, protecting from consequences associated with multiple pregnancies, as shown in Ilse review in this issue. However, even in single pregnancies infants born from assisted reproductive technology (ART) still show poor results as compare to spontaneous conceptions. These comparisons included the adjustment for many factors that could explain poor outcomes on unfertile couples. A recent study compares results on siblings conceived either by ART or spontaneously [1]. This study found that when comparing with siblings there were no differences in the outcome related to the conception. Authors concluded that the adverse perinatal outcome in ART pregnancies might be rather explained as an effect of maternal factors than the technology itself. Nearly all high-income countries organize their health-care systems around the principle of universal coverage; this approach requires that everyone within a country can access the same range of services according to needs and preferences, regardless of income, social status, or residency, and that people are empowered to use these services. Unfortunately, this is not the case in majority of low and middle-income countries where there still exist public and private medical care, and those women who are not fortunate enough to pay for their care, do not have the access to ART. A recent report from the Commission on Social Determinants of Health lead by the World Health Organization gave the principles to attain global health equity [2]. There is a long way ahead with an urgent need of strong actions from many actors. Health providers need to be actors in this aim and they should see how in every aspect of their care they can contribute to attain health equity provision and its outcome.