Infertility

Infertility is a condition of the reproductive system that impairs the conception of children, and it affects approximately 6.1 million individuals throughout the United States. The diagnosis of infertility is usually given to couples who have been attempting to conceive for 1 year without success.

Conception and pregnancy are complicated processes that depend upon many factors: 1) the production of healthy sperm by the man, 2) healthy eggs produced by the woman; 3) unblocked fallopian tubes that allow the sperm to reach the egg; 4) the sperm's ability to fertilize the egg when they meet; 5) the ability of the fertilized egg (embryo) to become implanted in the woman's uterus; and 6) sufficient embryo quality.

Finally, for the pregnancy to continue to full term, the embryo must be healthy and the woman's hormonal environment adequate for its development. When just one of these factors is impaired, infertility can result.

What causes infertility in women?
The most common female infertility factor is an ovulation disorder. Other causes of female infertility include blocked fallopian tubes, which can occur when a woman has had pelvic inflammatory disease or congenital anomalies (birth defects) involving the structure of the uterus and uterine fibroids are associated with repeated miscarriages. Aging is also an important factor in female infertility. The ability for ovaries to produce eggs declines with age, especially after age 35.

How is infertility diagnosed?
Couples are generally advised to seek medical help if they are unable to achieve pregnancy after a year of unprotected intercourse. The doctor will conduct a physical examination of both partners to determine their general state of health and to evaluate physical disorders that may be causing infertility. Usually both partners are interviewed about their sexual habits in order to determine whether intercourse is taking place properly for conception.

If no cause can be determined at this point, more specific tests may be recommended. For women, these include an analysis of body temperature and ovulation, x-ray of the fallopian tubes and uterus, and laparoscopy. For men, initial tests focus on semen analysis.

How is infertility treated?
Approximately 85 to 90 percent of infertility cases are treated with conventional therapies, such as drug treatment or surgical repair of reproductive organs. Assisted reproductive technologies, such as in vitro fertilization, account for the remaining infertility treatments.

What is in vitro fertilization?
For infertile couples where women have blocked or absent fallopian tubes, or where men have low sperm counts, in vitro fertilization (IVF) offers the chance of biological parenthood to couples.

In IVF, eggs are surgically removed from the ovary and mixed with sperm outside the body in a Petri dish ("in vitro" is Latin for "in glass"). After about 40 hours, the eggs are examined to see if they have become fertilized by the sperm and are dividing into cells. These fertilized eggs (embryos) are then placed in the women's uterus, by-passing the fallopian tubes.
IVF has received a great deal of media attention since it was first introduced in 1978, but it actually accounts for less than five percent of all infertility treatment in the United States.

Is in vitro fertilization expensive?
The average cost of an IVF cycle in the United States is $12,400. Like other extremely delicate medical procedures, IVF involves highly trained professionals with sophisticated laboratories and equipment, and the cycle may need to be repeated to be successful. While IVF and other assisted reproductive technologies are costly, they account for only three hundredths of one percent (0.03%) of U.S. health care costs.

Does in vitro fertilization work?
Yes. IVF was introduced in the United States in 1981; from 1985 through 1998 ASRM and its affiliate, the Society for Assisted Reproductive Technology (SART), have counted more than 91,000 births conceived through IVF. IVF currently accounts for about 98% of ART procedures, with combination procedures making up the remainder. The average live birth rate for IVF in 1998 was 29.1% per retrieval; a little better than the 20% chance in any one month that a reproductively healthy couple has of achieving a pregnancy and carrying it to term.

Do insurance plans cover infertility treatment?
The degree of services covered depends on where you live and the type of insurance plan you have. Fourteen states currently have laws that require insurers to either cover or offer to cover some form of infertility diagnosis and treatment. Those states are Arkansas, California, Connecticut, Hawaii, Illinois, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas and West Virginia. HOWEVER, the laws vary greatly in their scope of what is and is not required to be covered. For more information about the specific laws for each of those states, please call your state's Insurance Commissioner's office. To learn about pending insurance legislation in your state, please contact your State Representatives.

Whether or not you live in a state with an infertility insurance law, you may want to consult with your employer's director of human resources to determine the exact coverage your plan provides. If that isn't an option, an excellent resource for determining coverage is, "Infertility Insurance Advisor: An Insurance Counseling Program for Infertile Couples." This booklet is available for a small fee from RESOLVE, an infertility patient advocacy and information organization.

The desire to have children and be parents is one of the most fundamental aspects of being human. People should not be denied insurance coverage for medically appropriate treatment to fulfill this goal.

Acknowledgements to the American Pregnancy Association