In 1982, more than one in eight couples were classified as
infertile, that is, they had not used contraception and had failed
to
conceive for at least 1 year (1). The same year, nearly one in
five
ever-married women of reproductive age reported that they had
sought
professional consultation during their lifetimes to increase their
chances of having children (2).
The demand for infertility services has escalated markedly in
recent years (Figure 3) and continues to increase. The estimated
number of visits to private physicians' offices for
infertility-related consultation increased from approximately
600,000
in 1968 to over 900,000 in 1972 but has remained near that level
through 1980 (3). Beginning in 1981, requests for advice on
infertility rose again rather rapidly. By 1983, the number of
infertility-related visits had more than doubled to over 2 million.
If it is conservatively estimated that each infertility visit costs
$100, the health-care costs of infertility are at least $200
million
annually.
Infertile couples in the United States have a distinct
epidemiologic profile: they are older and more likely to be black
and
have had no previous children (Table 3). They also tend to have
received less than a high school education. In particular, the
risk
of infertility among women 35-44 years of age is double that of
women
30-34 years of age, and the risk is 1H times higher for blacks than
for whites (4). However, different characteristics predicted which
couples would seek infertility services (5). Although older and
black
women were more likely to be infertile in 1982, a larger proportion
of
younger and white women had requested medical evaluation of their
infertility within the previous 3 years. Women with fewer children
were more likely to have obtained infertility consultation than
women
with more children.
Reported by WF Pratt, WD Mosher, C Bachrach, MC Horn, National
Center
for Health Statistics; Div of Reproductive Health, Center for
Health
Promotion and Education, Div of Sexually Transmitted Diseases,
Center
for Prevention Svcs, CDC.
Editorial Note
Editorial Note: The prevalence of infertile couples in any
population
depends on such factors as: age distribution of the population,
age-specific infertility rates, age at which couples begin their
intended childbearing, type of contraceptive used before attempting
to
conceive, and time interval into which couples compress their
intended
childbearing. By the mid-1980s, in the United States, these five
factors appear to have interacted and caused an increase in the
number
of couples seeking treatment for infertility (3).
However, the increase in requested infertility services seems
to
have surpassed the increase in infertility, especially since the
mid-1970s. In fact, between 1965 and 1982, age-specific
infertility
increased substantially only among 20- to 24-year-olds. Although
this
is an important age group for childbearing (one of every three
births
occurs to mothers aged 20-24 years), the actual increase in
infertility confined to this age group is not large enough to
account
for the increase in infertility consultations.
Factors other than actual increases in age-specific infertility
also contribute to the rising demand for infertility services.
These
include: (1) the delayed age of initial childbearing, which
exposes
couples to higher age-specific infertility rates (6-8); (2) the
increased proportion of infertile couples seeking infertility
services
because of both an increased awareness of modern treatments for
infertility and a decreased supply of infants available for
adoption
(9); and (3) the greater number of physicians who offer infertility
services.
Unfortunately, the treatment of infertility is both costly and
often ineffective, even using modern surgical techniques (10).
Moreover, once established, this condition has a profound impact on
the emotional well-being and quality of life of the infertile
couple
(11). Thus, public health professionals must direct efforts toward
prevention rather than cure. A major available intervention to
reduce
infertility is to prevent that portion caused by sexually
transmitted
diseases (12,13). Sexually transmitted organisms, particularly
Chlamydia trachomatis and gonorrhea, lead to upper genital tract
infections and eventual tubal scarring. They account for an
estimated
30% of infertility in some high-risk populations in the United
States. Limiting numbers of sexual partners and use of barrier
contraceptives with spermicides can help prevent transmission of
sexually transmitted diseases, such as gonorrhea and chlamydia,
that
may cause infertility.
References
Pratt WF, Mosher WD, Bachrach CA, Horn MC. Understanding U.S.
fertility: findings from the National Survey of Family Growth,
Cycle III. Population Bulletin 1984;39:27-8.
Horn MC, Mosher WD. Use of services for family planning and
infertility: United States, 1982. Advance Data from Vital and
Health Statistics, No. 103. Hyattsville, Maryland: U.S.
Public
Health Service, Department of Health and Human Svcs, 1984.
Aral SO, Cates W Jr. The increasing concern with infertility.
Why now? JAMA 1983;250:2327-31.
Mosher WD, Pratt WF. Fecundity and infertility in the United
States, 1965-82. Advance Data from Vital and Health
Statistics,
No. 10. Hyattsville, Maryland: U.S. Public Health Service,
Department of Health and Human Services 1985.
Mosher WD. Special tabulation from National Survey of Family
Growth, Cycle III. Personal communication, January 11, 1985.
DeCherney AH, Berkowitz GS. Female fecundity and age. N Engl
J
Med 1982;306:424-6.
Schwartz D, Mayaux BH. Female fecundity as a function of age.
N
Engl J Med 1982;306:404-6.
Bongaarts J. Infertility after age 30: a false alarm. Fam
Plann
Perspect 1982;14:75-8.
Hogue CJR, Mollenkamp M. The increasing concern with
infertility
(Letter). JAMA 1984;252:208.
Freeman EW, Boxer AS, Rickels K, Tureck R, Mastroianni L.
Psychological evaluation and support in a program of in vitro
fertilization and embryo transfer. Fertil Steril
1985;43:48-53.
Sherris JD, Fox G. Infertility and STD: a public health
challenge. Pop Reports 1983;L:114-51.
Moore DE, Spadoni LR. Infertility in women. In: Holmes KK,
Mardh P-A, Sparling PF, Wiesner PJ, eds. Sexually transmitted
diseases. New York: McGraw Hill, 1984:763-73.
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