Time for Public Health Action on Infertility

Thirty years ago family planning was synonymous with using contraception and the prevention of pregnancy. Today, that definition has changed immensely to recognize the importance of helping couples achieve pregnancy. In general, infertility is defined as not being able to get pregnant (conceive) after one year of unprotected sex (6 months for women 35 or older). In the United States, infertility is widespread and affects about 6% of married women 15–44 years of age. An additional 12% of women ages 15-44 suffer from impaired ability to get pregnant or carry a pregnancy to a live birth, a condition referred to as impaired fecundity. While it is often thought of as just a women’s condition, both men and women contribute to infertility, with 9% of U.S. men reporting male-related infertility.  For couples experiencing difficulty conceiving, the effects of infertility can be devastating.

Infertility also has important public health implications. Given that many treatments result in twin and higher order births, both mothers and infants are at increased risk for adverse health outcomes.  Additionally, many known causes of infertility, such as sexually transmitted diseases, environmental exposures, obesity, and smoking, are well-known public health threats. While there is increasing recognition of how these factors affect fertility, there are still many opportunities to better understand and address population level issues that contribute to infertility in men and women.

In this fascinating session of Grand Rounds we delved into strategies associated with the detection, prevention, and management of infertility. This session also addressed clinical approaches to improving the safety and efficacy of infertility treatments in an effort to promote healthy pregnancy outcomes.