Defining Infertility

Anne T. Fidler and Judith Bernstein present a thoughtful and comprehensive review in their article, “Infertility: From a Personal to a Public Health Problem” [Public Health Rep 1999;114:494-511].

The authors point out an important concern—the lack of a consistent definition of infertility. In the insurance debate, infertility is often referenced as a “condition” rather than a “disease.” Resolve has worked to promote a consistent definition of infertility—one that not only focuses on the length of time it takes to conceive but also takes into account physiological factors. Infertility is a disease of the reproductive systems of both men and women that can result in the inability to conceive or to carry a pregnancy to a live birth. With this definition, infertility should be properly addressed as a disease.

There are several important considerations with regard to the complex issue of regulations. Currently, a good deal of regulation does exist in the field of infertility. The Fertility Clinic Success Rate and Certification Act has brought vital information to consumers and provides a system of checks and balances that has improved the quality of patient care.

Clinics are mandated to report their success rates, which are presented in a government publication and are periodically validated. Yet, as technology expands, there are new data and new treatments to evaluate in terms of the best interests of patients and resulting children.

The National Coalition for the Oversight of Assisted Reproductive Technologies (NCOART) was formed to review some of the critical issues in the use of these technologies. Participants include government agencies such as the Centers for Disease Control and Prevention and the Food and Drug Administration, medical societies such as the American Society for Reproductive Medicine and the associated Society for Assisted Reproductive Technology, and consumer groups such as RESOLVE, the National Infertility Association. NCOART represents all of the “partners” in the evaluation of infertility treatment and provides a forum in which the concerns of each can be discussed and debated.

As this debate continues, we must not lose sight of the personal and private nature of infertility and family-building while at the same time viewing the best interests of patients and resulting children from a public health perspective.