Addressing learning gaps to improve access to assisted reproductive technology in low-resource settings: Development...

Infertility is highly prevalent (20-40%) in sub-Saharan Africa, with limited access to assisted reproductive technology services. This study describes the development and evaluation of a low-cost oocyte retrieval simulator designed for use in resource-constrained environments. We developed and evaluated a low-cost oocyte retrieval simulator in Ghana. The exterior housing consists of a 3Dprinted vaginal canal. The interior design supports identifying mature follicles and retrieval skills with a web camera mounted to simulate an ultrasound view of the ovaries. Key considerations were low material cost, material availability in Ghana, and replication of the 'ultrasound view'. The simulator was evaluated across four domains: physical attributes, realism of experience, value, and relevance using 4-point rating scales (4=highest). Ability to perform tasks (5-point scales), and global value were evaluated. Mean ratings are reported. Across the four domains: physical attributes, realism of experience, value, and relevance, we report the evaluation scores using 4-point rating scales (4=highest). The ability to perform tasks was measured using the 5-point scales, and its global value was also scored. Given the ordinal nature of Likert-scale data and the small sample size, non-parametric statistical procedures were used. Group comparisons were conducted using the Mann-Whitney U test. The simulator demonstrated promising preliminary face and content validity, with higher ratings for value and relevance than for physical realism. This low-cost simulator represents an important step toward expanding ART training capacity in sub-Saharan Africa. Further iterative refinement and expanded validation are warranted.