Infertility: A truly global issue that does not discriminate and that we have the power to overcome
As medical students, residents, fellows and newly minted attending physicians, we pride ourselves in practicing evidence-based, data driven medicine. Statistics, randomized-controlled trials, level 1 evidence and highly powered studies are what contribute to our armory of data that we use to diagnose and treat medical issues.
Well, infertility is no exception and recent and current data is clearly showing that this is a growing global health issue that affects men and women regardless of ethnicity, social and economic class and geographic location.
The WHO recently published a report on Infertility and its global health impact. This report released on April 4, 2023 stated that approximately 17.5% of the adult population or roughly 1 in 6 worldwide will experience infertility in their lifetime, displaying the urgent need to increase funding, public support, research and access to those who need high-quality affordable fertility care to build their families.
What can we do about this increasingly prevalent health issue? Especially for professional women, and particularly for women in medicine, infertility is a growing problem, with many female MDs experiencing infertility during their training and/or professional careers.
But we are lucky. We are living in an age of Reproductive technological advancements.
Early fertility testing and intervention is not only possible but easily accessible and becoming more affordable. -Getting a referral to see a fertility doctor is relatively simple. Primary care doctors are understanding the importance of family planning and they are discussing childbearing goals with their patients: when they may consider starting a family and whether it is now or later. For female physicians-in-training this is often later given the years dedicated to medical education and training hence the opportunity to consider elective fertility preservation thru IVF. Primary care providers and physician MDs should be open to referral to a fertility specialist for a “fertility check” and consideration for IVF and egg or embryo freezing and an evaluation for common gynecologic issues that can effect fertility. It is actually very easy to check a women’s fertility. A simple pelvic ultrasound with an AFC (antral follicle count) and blood test (AMH: antimullarian hormone) combined with history, physical exam and age can give a snapshot of current fertility and ovarian reserve.
Option to freeze eggs or embryos: Assisted reproductive technology has become incredibly advanced and our ability to freeze eggs and embryos which can achieve high success rates with thaw and high clinical pregnancy rates makes egg and embryo freezing a viable option for women in the age ranges of 20 up to their late 30s. Women in this age group can expect to freeze a healthy number of eggs or embryos by doing one or two IVF cycles with the near promise of achieving one or more live births from their frozen eggs or embryos with a high success rate. In the not so far future and with the intervention of AI (artificial intelligence), we may even be able to potentially predict which eggs will become healthy babies.
Accessibility and Affordability: Many employers and third-party insurance providers are covering fertility treatments including fertility preservation cycles. Employers are quickly realizing that in order to attract and retain qualified employees they need to provide fertility benefits so that women are not worried about the conflicts between their professional careers and family building goals. Ideally, training programs and hospital and office based medical coverage plans should and will include fertility benefits that MDs and MDs in training can use to help offset costs of fertility treatment.
Starting a family during medical training: For those people who want or need to start trying to conceive sooner, medical programs are understanding the importance of family planning, the prevalence of infertility and the need to support and provide time and scheduling to incorporate fertility treatment, and pregnancy into a physician’s busy schedule. Undergoing fertility treatment or having children during medical school, residency or fellowship is not considered acceptable and programs are open and understanding to provide a reasonable schedule to incorporate and accommodate these situations.
Talk to your primary care doctor, gynecologist and insurance provider about an early fertility evaluation, when the right time is to start a family and consider fertility preservation as a backup for your future!
Happy National Infertility Awareness Week!
Dr. Prati A. Sharma MD