Sianne Hazel
General infertility, as defined by the World Health Organization, is a disease of the reproductive system characterized by the failure to achieve a clinical pregnancy after twelve or more months of regular, unprotected intercourse, and it can be the result of complication in either partner, male or female. However, there are two characteristic types of infertility: primary and secondary. Primary infertility is when a couple is unable to maintain pregnancy without ever having successfully done so in the past, and secondary infertility is when a couple previously had a successful childbirth and is now unable to maintain pregnancy (WHO, 2020). Male infertility makes up about a third of infertility cases and can be due to low sperm count, abnormal sperm function, or blockages in the sperm pathway (Mayoclinic, 2018). Female infertility makes up another third of typical cases and can be the result of ovulation disorders, damage to the fallopian tubes, or uterine or cervical issues (Mayoclinic, 2019). The remaining third of infertility cases remain unexplained. Treatments for infertility are dependent on the cause and can range from surgery, to hormone supplementation, to a more direct approach with artificial reproductive technology, or ART. There are three main forms of ART: intrauterine insemination (IUI), in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). The method that a couple decides to use is dependent on their specific case, mainly the causes of their infertility, that make some methods more likely to be successful for that couple. Though it is still a relatively new field, ART has been increasingly used to treat infertility around the world. However, there remains a disparity in the access and use of infertility treatments by individuals in different countries.
Rates of infertility have been known to vary between countries separated by income level. Measuring the percentage of women aged 20-44 who were unable to achieve a live birth in 2010, the US showed 2% of women experiencing primary infertility, and 5.2% secondary. France had 2.1% primary and 8.8% secondary, and Japan had 1.4% primary and 7.3% secondary. On the other hand, lower income countries such as Nigeria had 2.2% primary and 13.8% secondary, the Democratic Republic of Congo had 2% primary and 12.2% secondary, and Myanmar had 2% primary and 10.6% secondary infertility rates (Mascarenhas et. al, 2012). There is a clear trend seen specifically in the number of women experiencing secondary infertility with higher percentages in the lower income countries. In terms of the use of treatments for infertility in these differing countries, the US had 12% of women aged 15-44 using some form of treatment from 2011-2015, translating to roughly 7.3 million women (CDC, 2017). Meanwhile treatment for infertility in Nigeria is not covered by their National Health Insurance Scheme so instead, individuals turn to traditional healers and medicine for treatment (Agholor, 2017). The gap between infertility rates and access to sophisticated medical treatment in certain countries highlights the need for improved health policy and allocation of resources for these services.
The disparity in access to infertility treatment not only negatively affects individuals physically, but people can also experience adverse mental and psychological effects, especially in lower income countries where the inability to reproduce is a punishable trait. In many sub-Saharan African countries, the stigma surrounding infertility targets women as being the cause of the disease and results in husbands leaving their wives homeless and penniless when they cannot bear children. In such communities that lack proper knowledge of male infertility, women become marginalized and are forced to carry the burden of seeking treatment that is expensive and, in some cases, unnecessary because it is the male who was infertile (Agholor, 2017). The fear of infertility and societal pressures to have multiple children can also deter some couples from using contraceptives, which drastically increases the rates of contracting sexually transmitted infections. The overlying issue of lack of resources for and access to infertility treatment leads to a cascade of resulting public health concerns which, when not addressed properly, will feed back into the cycle. By improving global access to the resources necessary for infertility treatment, gender inequality and the social stigma around infertility can begin to dissipate.
Combatting this global issue starts with furthering the education surrounding infertility, its causes, preventative measures, and appropriate treatments. With more education comes the universal understanding that infertility is a disease and should be treated as such. To do this, the topic of infertility should be included among those that are taught in nation-wide sexual education programs in schools. In addition, public health experts must reach out to other religious and community leaders offering to give presentations to their specific audiences to reach across age groups. The curriculum may look different between countries depending on the prevalence of specific causes of infertility in that area, and the availability of resources for treatment. For example, in a country where the primary cause of infertility is biological interference from an STI, there would be more stress placed on preventative measures of contracting STI’s like safe sex practices. This could also be the case in a region that has limited resources for treating STI’s, so the root of the problem would be addressed through prevention education. However, in-depth education should not only go to those outside of the medical field. There is also an alarming need for knowledgeable and trained medical personnel who can appropriately treat patients seeking infertility treatment (WHO, 2020). Increasing the success of infertility treatments can help lessen the financial burden of recurring doctor’s visits for continuous treatment, and it can also help improve fertility rates generationally.
Governmental policies surrounding healthcare and the allocation of funds would also need to improve. Including the cost of fertility treatments in national healthcare coverage will allow access to these facilities to significantly more individuals who are deterred from seeking treatment due to the extremely high cost. To do so, more funds must be allotted to the public health sectors of government. However, this poses a larger issue because there is so little money in these lower income countries to begin with, it becomes difficult to prioritize certain aspects of society when the fate of others is so dire. In
addition, the high cost of purchasing, shipping, and properly maintaining the necessary equipment for these treatments must also be considered.
The inequity in access to adequate treatment for infertility remains a global concern, even as reproductive technologies continue advancing through the present day. Unfortunately, though many possible solutions have been presented by organizations like the WHO, it will be long before the large-scale solutions are adequately carried out, and it will be even longer before their benefits are seen on a global scale. In the meantime, it is imperative that the smaller efforts such as educating individual communities on infertility continue to grow until the larger-scale solutions can be implemented.
Rates of infertility have been known to vary between countries separated by income level. Measuring the percentage of women aged 20-44 who were unable to achieve a live birth in 2010, the US showed 2% of women experiencing primary infertility, and 5.2% secondary. France had 2.1% primary and 8.8% secondary, and Japan had 1.4% primary and 7.3% secondary. On the other hand, lower income countries such as Nigeria had 2.2% primary and 13.8% secondary, the Democratic Republic of Congo had 2% primary and 12.2% secondary, and Myanmar had 2% primary and 10.6% secondary infertility rates (Mascarenhas et. al, 2012). There is a clear trend seen specifically in the number of women experiencing secondary infertility with higher percentages in the lower income countries. In terms of the use of treatments for infertility in these differing countries, the US had 12% of women aged 15-44 using some form of treatment from 2011-2015, translating to roughly 7.3 million women (CDC, 2017). Meanwhile treatment for infertility in Nigeria is not covered by their National Health Insurance Scheme so instead, individuals turn to traditional healers and medicine for treatment (Agholor, 2017). The gap between infertility rates and access to sophisticated medical treatment in certain countries highlights the need for improved health policy and allocation of resources for these services.
The disparity in access to infertility treatment not only negatively affects individuals physically, but people can also experience adverse mental and psychological effects, especially in lower income countries where the inability to reproduce is a punishable trait. In many sub-Saharan African countries, the stigma surrounding infertility targets women as being the cause of the disease and results in husbands leaving their wives homeless and penniless when they cannot bear children. In such communities that lack proper knowledge of male infertility, women become marginalized and are forced to carry the burden of seeking treatment that is expensive and, in some cases, unnecessary because it is the male who was infertile (Agholor, 2017). The fear of infertility and societal pressures to have multiple children can also deter some couples from using contraceptives, which drastically increases the rates of contracting sexually transmitted infections. The overlying issue of lack of resources for and access to infertility treatment leads to a cascade of resulting public health concerns which, when not addressed properly, will feed back into the cycle. By improving global access to the resources necessary for infertility treatment, gender inequality and the social stigma around infertility can begin to dissipate.
Combatting this global issue starts with furthering the education surrounding infertility, its causes, preventative measures, and appropriate treatments. With more education comes the universal understanding that infertility is a disease and should be treated as such. To do this, the topic of infertility should be included among those that are taught in nation-wide sexual education programs in schools. In addition, public health experts must reach out to other religious and community leaders offering to give presentations to their specific audiences to reach across age groups. The curriculum may look different between countries depending on the prevalence of specific causes of infertility in that area, and the availability of resources for treatment. For example, in a country where the primary cause of infertility is biological interference from an STI, there would be more stress placed on preventative measures of contracting STI’s like safe sex practices. This could also be the case in a region that has limited resources for treating STI’s, so the root of the problem would be addressed through prevention education. However, in-depth education should not only go to those outside of the medical field. There is also an alarming need for knowledgeable and trained medical personnel who can appropriately treat patients seeking infertility treatment (WHO, 2020). Increasing the success of infertility treatments can help lessen the financial burden of recurring doctor’s visits for continuous treatment, and it can also help improve fertility rates generationally.
Governmental policies surrounding healthcare and the allocation of funds would also need to improve. Including the cost of fertility treatments in national healthcare coverage will allow access to these facilities to significantly more individuals who are deterred from seeking treatment due to the extremely high cost. To do so, more funds must be allotted to the public health sectors of government. However, this poses a larger issue because there is so little money in these lower income countries to begin with, it becomes difficult to prioritize certain aspects of society when the fate of others is so dire. In
addition, the high cost of purchasing, shipping, and properly maintaining the necessary equipment for these treatments must also be considered.
The inequity in access to adequate treatment for infertility remains a global concern, even as reproductive technologies continue advancing through the present day. Unfortunately, though many possible solutions have been presented by organizations like the WHO, it will be long before the large-scale solutions are adequately carried out, and it will be even longer before their benefits are seen on a global scale. In the meantime, it is imperative that the smaller efforts such as educating individual communities on infertility continue to grow until the larger-scale solutions can be implemented.
References:
Agholor K. 2017 Apr 17. The Burden of Infertility in Nigeria: Raising Visibility to Promote Equitable Access to Care. Maternal Health Task Force. [accessed 2020 Dec 8]. https://www.mhtf.org/2017/04/06/the-burden-of-infertility-in-nigeria-raising-visibility-to-promote equitable-access-to-care/
Everymum. 2018 Jul 24. Expert Advice: What You Need To Know About Fertility Issues. everymum. [accessed 2020 Dec 8]. https://www.everymum.ie/getting-pregnant/fertility/expert-advice-what-you-need-to-know-about-fe rtility-issues/
Female infertility. 2019 Jul 27. Mayo Clinic. [accessed 2020 Dec 8]. https://www.mayoclinic.org/diseases-conditions/female-infertility/symptoms-causes/syc-20354308
Global Fertility. 2012. Family Choices | Interactive map of fertility and infertility. [accessed 2020 Dec 8]. https://globalfertilitymap.com/
Infertility definitions and terminology. 2020. World Health Organization. [accessed 2020 Dec 8]. https://www.who.int/teams/sexual-and-reproductive-health-and-research/key-areas-of-work/fertility -care/infertility-definitions-and-terminology
Infertility. 2020 Sep 14. World Health Organization. [accessed 2020 Dec 8]. https://www.who.int/news-room/fact-sheets/detail/infertility
Male infertility. 2018 Sep 20. Mayo Clinic. [accessed 2020 Dec 8]. https://www.mayoclinic.org/diseases-conditions/male-infertility/symptoms-causes/syc-20374773
NSFG - Listing I - Key Statistics from the National Survey of Family Growth. 2017 Jun 20. Centers for Disease Control and Prevention. [accessed 2020 Dec 8]. https://www.cdc.gov/nchs/nsfg/key_statistics/i.htm
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