I had the opportunity a few weeks ago to lobby on Capitol Hill for legislation and initiatives aimed at improving the care for the 7.3 million Americans who face infertility. At first glance I was disappointed to learn that instead of advocating for the passage of the Family Act of 2013 to provide a tax credit toward treatment, I would be discussing the Center for Disease Control’s National Public Health Action Plan for the Detection, Prevention, and Management of Infertility.
I had no idea how I would characterize the value of this plan, and as a former infertility patient, it didn’t have the direct tangible impact that a tax credit promised.
Then I actually read the white paper that sets the foundation for what this plan hopes to accomplish. When I finished the last sentence, I realized that this is a game changer for the entire infertility population and their caregivers.
One thing that has always frustrated me is how infertility is so often characterized as an elective quality of life issue, rather than a disease. I’ve seen posts over the years that accuse infertile couples of ‘vanity’ for wanting to have a biological child so badly that they are willing to go through so much expense and physical pain when there are so many children out there “they could just adopt.”
Besides minimizing the magnitude of the decision making involved in adoption, this impression, in large part, results from a lack of consideration of infertility as a public health issue. The National Public Health Action Plan changes that.
The Four Primary Goals of the CDC National Public Health Action Plan
There are four primary goals the plan hopes to accomplish.
- To reduce the burden of infertility and reduced fecundity in the United States
- By promoting behaviors that maintain fertility
- By promoting prevention, early detection, and treatment of infections (such as chlamydia) and other medical conditions that lead to infertility
- By removing or reducing environmental threats to fertility
- To improve access to the diagnosis and treatment of infertility and eliminate disparities in infertility care
- To improve the efficacy and safety of infertility treatment
- To improve the quality of life of Americans who live with infertility
The reason this is so important is that it elevates the debate over infertility, from a quality of life issue, to one of disease prevention and treatment. The CDC will be working with federal agencies, professional and consumer organizations, the scientific community, the healthcare community, industry, and other stakeholders to develop a national health plan for the prevention, detection and management of infertility.
Explaining Goal #1
Goal #1a: To reduce the burden of infertility and reduced fecundity (being able to carry a baby full term) by promoting behaviors that maintain fertility.
I remember times when I would try to figure out if there was anything we could have done to change our situation before we started trying to have a baby. Little research has been done to truly understand the causes behind the rise of infertility rates, as the focus has been on medical treatments to get around the problems, rather than prevent or even cure them.
Although it may not be considered a ‘behavior,’ the effect delaying having a child has on fertility success needs to be a part of any public health information dissemination program. Couples need to know the critical cut off ages for optimal success with infertility treatment, and women of childbearing age should begin receiving this information long before they get into college and start careers. Since infertility is considered a disease by the American Society of Reproductive Medicine, this type of public awareness fits neatly into the ‘prevention’ box.
The socioeconomic framework of this country isn’t going to change any time soon. A utopian fertility workplace would allow women to have children at any age without having to worry about lost employment or tenure opportunities, but that workplace simply doesn’t exist.
Public awareness of fertility preservation for women and men at younger ages could help prevent ‘emergency’ fertility measures later in life. With the recent advances in cryopreservation for eggs (oocytes) and sperm, many of these emergencies could be avoided, or at least give a couple better odds of success.
Goal 1b: Promoting prevention, early detection, and treatment of infections (such as chlamydia) and other medical conditions that lead to infertility.
The CDC believes a proportion of preventable infertility burdens could be substantial, but more research is needed. Tubal infertility affects 18% of the couples who need assisted reproduction, and this is often the result of chronic pelvic inflammatory disease (PID), which can be treated by the early detection and treatment of sexually transmitted diseases.
Polycystic ovary syndrome (PCOS) has been linked to infertility for years, and the CDC proposes more research on how this metabolic disorder is significantly reducing the fertility rates in women. Obesity is also associated with decreased fertility, and this epidemic problem is known to increase the risk of miscarriage and decrease the effectiveness of reproduction. This has already been addressed in many practices with the treatment of PCOS with drugs like Metformin, but behaviors could be adjusted before seeking fertility that might improve outcomes and avoid high tech and costly infertility procedures.
For people with known health problems, or cancer diagnosis, the ability to preserve sperm and eggs through cryopreservation could allow for a better fertility outcome after treatment, before the damage of radiation treatment or medication does permanent damage to reproductive organs.
Goal 1c: Removing or reducing environmental threats to fertility.
Male factor contributes to nearly half of the cases of infertility, and research into not only the growing frequency of ‘varicoceles’ that impair male fertility, but environmental and occupational hazards that men encounter in a workplace (that has over 84,000 known chemicals) that are likely causes of declining human sperm quality in industrialized nations. Many men don’t bother having themselves checked for the easily fixable blockages in their reproductive system, and may go years through infertility without having the problem addressed.
Understanding what chemicals in the workplace that contribute to infertility could help improve fertility outcomes, and help men adjust safety protocols on the job to protect their reproductive organs.
These are just a few examples of how comprehensive this program is. If behaviors regarding sexually transmitted diseases, or obesity and its contribution to infertility could be communicated through the CDC National Health Action Plan, then a plan could be developed that preserves fertility for these couples before they get to an age, or stage, where treatment is not as effective.
In the next article, we’ll discuss Goal #2: To improve access to the diagnosis and treatment of infertility and eliminate disparities in infertility care.