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Path To Fertility Blogger Lisa Rosenthal  

Lisa Rosenthal has over twenty-five years of experience in the fertility field, including her current roles as Coordinator of Professional and Patient Communications for RMACT and teacher and founder of Fertile Yoga, a class designed to support, comfort and enhance men and women's sense of self. Her experience also includes working with RESOLVE: The National Infertility Association and The American Fertility Association, where she was Educational Coordinator, Conference Director and Assistant Executive Director

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International Infertility Experts On IVF Cost and More

  
  
  

IVF Cost and More

IVF cost and cost of fertility treatmentThere's a little bit of everything, or something for everyone today on PathtoFertility. There is more from ASRM and it's about IVF cost and the cost of fertility treatment. Love that it's making headlines today all over the world! Read below for ASRM's press release statement. 

 

Closer to home, we have our double winner this evening in Norwalk. Fertile Yoga from 5:45-6:45, followed by Ladies Night In. Come join us for gentle, compassionate and relaxing movement with guided meditation and then have a lovely meal and the company of women who are experiencing similar things to you. We laugh, we cry, we nod a lot. While you may walk into the group thinking that you are the craziest fertility treatment patient ever, you will walk out knowing that many of the feelings that you are having are more normal you ever realized. Hope to see you tonight! Come to 20 Glover Avenue, Norwalk CT. Free and open to the public. 

 

Update from Infertility Experts at ASRM and IFFS Meeting

HIGHLIGHTS FROM THE INTERNATIONAL FEDERATION OF FERTILITY SOCIETIES'

21st WORLD CONGRESS ON FERTILITY AND STERILITY AND 

THE 69th ANNUAL MEETING OF THE 
AMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE

 

Cost Biggest Anxiety for IVF Patients

 

Boston, MA – Research presented at the International Federation of Fertility Societies/American Society for Reproductive Medicine meeting showed that finances were a leading concern of patients undergoing In Vitro Fertilization (IVF) procedures.

 

Only a small minority of the world’s population is assured free or reduced cost access to infertility treatments. An IVF program in Brazil surveyed more than 5000 patients and asked them which of the following was their main concern about undergoing IVF: financial, multiple gestation, malformation of the offspring, social prejudice, religion or supernumerary embryos. An overwhelming majority (82.6%) identified financial concerns as their primary worry.

 

Dr. Richard Kennedy, Secretary General of the IFFS said, “Those who want children and can’t have them undergo great heartache. Infertility is a disease, and should be treated in the same way as any other disease by health services and insurance plans. Yes, it can often be expensive in the short term, but many studies show that the payback to society from successful infertility treatment more than justifies the initial outlay.”

 

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Breaking Infertility News From ASRM (American Society for Reproductive Medicine)

  
  
  

Infertility News from the ASRM Annual Meeting

ASRM Annual MeetingOnce a year, doctors, nurses, lab directors, clinicians, and other professionals in the field of infertility and fertility treatment come together for a professional meeting. The group is called ASRM, American Society of Reproductive Medicine; this year the conference is being held in Boston. And it’s being held this week.

 

Papers are being presented. Research is being reviewed. Videos are being presented. Prizes based on academic and scientific excellence are being awarded. This is the largest conference in the United States, meeting yearly, to take an in-depth look at infertility and the advances of the last year.

 

Here is a just a teaser on what we will be hearing from the conference. A highlight. Or two.

BPA and Pregnancy

One, a further statement about plastic and our reproductive health. We’ve been hearing about BPA and pregnancy for years. Maybe some of us still doubt how serious these concerns are, but the scientists don’t question it all that much anymore. They are pretty clear. Here’s what Dr. Linda Giudice, President of ASRM had to say about the studies about BPA (a chemical that is in and released from plastics) presented at the conference.  "Many studies on environmental contaminants' impact on reproductive capacity have been focused on infertility patients and it is clear that high levels of exposure affect them negatively," Dr. Linda Giudice, president of ASRM, said in a statement. "These studies extend our observations to the general population and show that these chemicals are a cause for concern to all of us."

IVF Success

Big news as well at the conference about how many IVF births have been achieved since the birth of Louise Brown via IVF success thirty-five years ago.

 

Births have increased exponentially over the years, according to the research. In 1990, a little more than a decade after the first IVF birth, about 95,000 babies were born. By 2000, that figure had grown to nearly 1 million, and by 2007, it had climbed to more than 2 million.

 

Aggregating ten international reports tracking the use of Assisted Reproductive Technologies (ART) the International Committee for the Monitoring of Assisted Reproductive Technology (ICMART) estimates that there have been 5 million babies born with the help of ART.

 

More ASRM Conference News

 

Stay tuned for more news from the ASRM conference. We are looking forward to posting information from the RMACT doctors, clinical staff and team members who are attending this year’s conference.

 

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The Fantasty of Fertility Treatment - ASRM Response and Mine

  
  
  

ASRM Responds to NY Times Op-Ed on Fertility Treatment

NY Times Op Ed Selling the Fantasy of FertilityToday is supposed to be medical Monday, but there’s been so much buzzing around in the media these days that it’s hard to know where to even start.

 

Since it is medical Monday, I think I’ll start a little backwards.

 

Linda Guidice is the president of ASRM; here’s her response to an op-ed piece in the New York Times:

 

Photo: Adam Kinney, Flickr Creative Commons

 

We believe that "Selling the Fantasy of Fertility" (September 12) paints an incomplete picture of the likely success of infertility treatments.

 

Despite the dramatic advances in medicine of the last 30 years, it is true not every infertility patient will get pregnant, but patients and the public deserve to have all the facts. Among those facts the authors failed to mention are that ART treatments alone have resulted in the birth of more than 5 million babies around the world, and while it sometimes takes more than one attempt, more than 60% of women who undergo ART treatments eventually end up with a baby.

 

We, like the authors, recognize the tremendous emotional distress that can result for patients whose treatments are not successful, and hence the need to have transparency and full disclosure of available data for decision making in infertility therapy and coping with the emotional aspects that accompany it.

 

Linda C. Giudice, MD, PhD

President

American Society for Reproductive Medicine

Truth in the Op-Ed "Selling the Fantasy of Fertility"

Jumping back to the op-ed piece itself ("Selling the Fantasy of Fertility"), the final paragraph was the part that spoke eloquently and rang with truth, with no judgment. Much of the rest of the op-ed was subjective, to say the least. It spoke of the authors' experiences and they should be applauded for bringing to light the issue of when to end treatment and that, in fact, ending treatment is as brave and strong as continuing. I certainly agree.

 

Being unable to bear children is a painful enough burden to carry, without society’s shaming and condemning those who recognize that their fertility fantasy is over. It is time to rein in the hype and take a more realistic look at the taboos and myths surrounding infertility and science’s ability to “cure” it.


Miriam Zoll is the author of the memoir “Cracked Open: Liberty, Fertility and the Pursuit of High-Tech Babies.” Pamela Tsigdinos is the author of the memoir “Silent Sorority: A Barren Woman Gets Busy, Angry, Lost and Found.”

 

Finding Our Own Journey During Infertility


Still, we all find our own journey and each of us does have to find our own ending.

 

Having been a patient myself, worked with not-for-profit patient organizations for decades, run peer support groups and more, my experience is that giving up the dreams of a lifetime is a painful struggle that is more internal than external. Yes, society brings pressure to bear in terms of family but not nearly the pressure we put on ourselves. Acknowledging that there is marketing that goes on around infertility and fertility treatment, I understand the author’s point that there’s pressure there as well.

 

And while the “industry” is here to help create families, I hear more frequently that doctors will gently try to convince patients to give up treatment and that patients are resistant to that rather than the other way around. Maybe that proves the authors' point?

 

Perhaps.

 

Or perhaps giving up the dream of a biological child, magical thinking or not, is something that takes time and effort.

 

And courage.

 

As the authors pointed out.

 

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Infertility Basics- One Baby at a Time, Whenever Possible

  
  
  

Infertility Basics- ESET- Elective single embryo tranfer- Why one baby at a time.
Infertility Basics.

 

Why one baby at a time?Infertility Basics- Elective Single Embryo Transfer (ESET) One baby at a time

 

Some very simple basic reasons.

 

Healthier pregnancy.

 

Healthier mother.

 

Healthier baby.

 

Why am I talking about this?

 

Because once again, I spoke to a patient who was hoping for twins. One boy, one girl. Done.

 

I get it.

 

Never have to go through fertility treatment again?

 

I get it.

 

We all get it, actually.

 

Your doctors, your nurses, your medical staff, they get it too.

 

But we also get how much more challenging a pregnancy is with more than one baby.

 

We want you to have the healthiest possible outcome.

 

We all see multiple pregnancies that are healthy and uncomplicated.

 

We also see babies that have serious health problems and mothers that are on bedrest for months at a time, often with their own health problems.

 

We try to avoid this. We are encouraged to avoid this. Both SART (Society for Assisted Reproductive Technologies) and ASRM (American Society for Reproductive Medicine), the two professional organizations dedicated to reproductive medicine, ask us too. Tell us to, actually.

 

There are guidelines that infertility programs in the United States are supposed to follow. the guidelines dictate how many embryos are transferred in an IVF cycle. The amount of embryos depend mainly on diagnosis and age of mother.

 

Most infertility programs follow these guideline. Check. Ask. If your program does not follow these guidelines, you may want to consider a different program.

 

Yes, we do get it. Creating a family via fertility treatment is very challenging and stressful. Not to mention time consuming and financially difficult.

 

Having the chance to do it all at once is tempting. Very, very tempting.

 

We want to support you having as healthy a family as possible.

 

That's our job.

 

Infertility Basics- Real Cost, Real Definition?

  
  
  

Infertility Basics- PathtoFertility Blog-What does infertility really cost?

Infertility Basics

 

Here's one thing you might not know about infertility, treatment and disease.

 

While vital for some patients, in vitro fertilization and similar treatments account for less than 3% of infertility services, and about (or approximately) seven hundredths of one percent (0.07%) of U.S. health care costs.  

 

That information is straight from ASRM (American Society for Reproductive Medicine). Pretty weighty stuff. 

 

Infertility, while it seems so expensive, only accounts for about seven hundredths of one per cent of U.S. health care costs.

 

That’s mind boggling. Especially when your insurance often doesn’t cover infertility treatments.

 

Even though infertility is considered a disease of your reproductive system.

 

Infertility was recognized as a disease by the World Health Organization. Not an inconvenience. Not a lifestyle “problem” or choice. Or punishment.

 

A disease.

 

One that should be able to be treated.

 

A disease that should be covered by insurance companies just as any other disease of any other system.

 

I’m not a huge fan of the word should. Especially when it is applied to feelings.

 

But here?

 

It’s the perfect word.

 

Infertility is a disease of the reproductive system.

 

It should be covered by insurance companies.

 

Our friends, family, colleagues should know what it actually costs in the U. S. to cover it.

 

We should be able to have the disease of infertility covered.

 

We should.

 

Infertility Basics- Why Infertility and Not Fertility Basics?

  
  
  

Infertility Basics- Why Infertility and Not Fertility?

Infertility is defined by most fertility specialists, as well as ASRM (American Society for Reproductive Medicine), ACOG (the American Congress of Obtetricians and Gynecologists), and the CDC (Center for Disease Control) as the inability to become pregnant after one year of correctly timed intercourse.

 

Fertility is defined as the ability to get pregnant before that one year time period.

 

Fertility and infertility are often closer than that though.

 

There is also sub-fertility, defined as a diminished or marginal chance of getting pregnant.

 

Recently I recieved a comment to a Infertility Basics blog, run every Monday, about my choice of language.

 

"Why not use the word fertile instead of infertile?", was the specific comment.

 

The reader went on to say how much less negative using the word fertile is as opposed to infertile.

 

I've thought about it quite a bit since then.

 

It's a multi-layered answer.

 

First, if a man or a woman is having trouble conceiving or thinking that they might be, and they do a search on the internet, they type in the word infertile.

 

This isn't a guess on my part. I have a wonderful colleague who shows me data and can unequivacably document that is what is typed in for a search.

 

Infertility. Not fertility.

 

This blog serves many purposes. One is to help someone just beginning this journey.

 

There are many of you who are reading who could recite the statistics of infertility, the causes, the treatment, in your sleep, you are that well versed in the language.

 

Some of you read the blog for the medical information.

 

Some of you read it for the support.

 

Some of you read it for updates on the seminars, workshops and classes that RMACT offer.

 

And some of you come because our blog comes up if you type in infertility and do a search.

 

You are all welcome.

 

And for those of you here for the first time, and maybe not even sure of the name of this blog?

 

It's PathtoFertility.

 

It's finding our way to building our families.

 

Sub-fertility is one of my favorite terms and has been for over two decades. It relates back to the word yet, which I waxed philosophical about last week.

 

Perhaps it's the best way of saying that we need help. Sub-fertile. A marginal or diminished possibility of getting pregnant.

 

Not an inability.

 

Just a place where you need help.

 

And that's what we offer.

 

Help.

 

 

 

 

 

Infertility 101- Evaluation of the Uterus- American Society of Reproductive Medicine Factsheet

  
  
  

Wednesday text Infertility patients have a great resource when it comes to reliable, well researched educational material. The American Society for Reproductive Medicine provides that information. Here's a comprehensive overview of what an evaluation of the uterus is.

 

FERTILITY RESOURCES

American Society for Reproductive MedicinePATIENT FACT SHEET
Evaluation of the Uterus

This fact sheet was developed in collaboration with The Society of Reproductive Surgeons

If you are trying to get pregnant for more than one year (or six
months if you are 35 years or older) and have not been successful, a series of tests will be performed to find the cause of your infertility. Your doctor will test your reproductive organs (fallopian tubes and uterus), your partner's sperm, and possible blood tests to check for hormonal problems.

 


The examination of your uterus (womb) is one of the more
important tests that you will undergo. Your doctor will make sure
there is nothing that could prevent the fertilized egg (embryo) from implanting and growing. Abnormal tissue growths (such as endometrial polyps and fibroids) and scar tissue within the uterine
cavity can prevent implantation.

How will the doctor examine my uterus?
There are many different ways for your doctor to look at your
uterus. These include:

  • Vaginal Ultrasound- A vaginal ultrasound utilizes a probe that is placed inside the vagina. The probe transmits sound waves that allow visualization of the organs in and around the pelvic cavity. The use of vaginal ultrasound helps the doctor see the wall and lining of your uterus.
  • Sonohysterogram- (Saline Infusion Ultrasound). When the inside cavity of the uterus needs to be evaluated, your doctor may want to perform a saline infusion ultrasound. During this procedure, a small amount of sterile solution is placed into your uterus for a better look at the cavity.
  • Hysterosalpingogram- This procedure provides information about the fallopian tubes and uterine cavity. The doctor injects a special dye into your uterus and then performs an x-ray to visualize the path of the dye through the fallopian tubes. This test allows your doctor to determine if the fallopian tubes are open.
  • Hysteroscopy-This procedure is performed with a small telescope attached to a camera (called a hysteroscope) that lets the doctor look inside your uterus. Because the doctor has a direct view of your uterus, this procedure may provide the most accurate information. How is hysteroscopy performed?
  • Diagnostic hysteroscopy- Hysteroscopy is sometimes used to diagnose a condition involving the uterine cavity. Though the majority of hysteroscopic procedures are performed in a hospital operating room, diagnostic hysteroscopy can also be done in the doctor's office, usually without narcotic pain medication. If your doctor performs this procedure in the office, he or she may give you ibuprofen and medication to numb your cervix. The doctor will then insert the hysteroscope through your vagina into the cervix. Because the hysteroscope is attached to a camera, both you and your doctor can watch the procedure on a television screen. After the procedure is performed, you can usually return to your normal activity just as you would after an annual gynecologic exam.

 

  • Operative hysteroscopy-Hysteroscopy can also be performed to remove tissue or growths that interfere with fertility. The hysteroscope that is usually used for operating is larger than the one used for diagnosing problems in the uterus, so you will need general, epidural or spinal anesthesia; and the procedure will probably be done in a hospital or outpatient facility. After operative hysteroscopy, there is very little discomfort since there were no incisions made.

Both the office and operative hysteroscopy are performed
through the opening of your cervix. If the cervix was stretched
(dilated), your doctor may advise you to avoid swimming, taking a
bath, or placing anything in the vagina for up to two weeks (this
includes avoiding sexual intercourse). This will allow the dilated
cervix to return to its normal size and will reduce the risk of infection.


What can a doctor diagnose and treat with hysteroscopy?

 

  • Endometrial polyps are lesions commonly found in infertility patients. Polyps are an overgrowth of the tissue that lines the uterine cavity or cervix. Depending on their size and location, polyps are either removed in the physician's office or in an operating room.

 

  • Uterine fibroids are noncancerous growths in your uterus. These growths can cause heavy bleeding if they are in the inside of the uterus. A hysteroscope can be used to remove these growths.
  • Intrauterine scar tissue- can be removed with either office or operative hysteroscopy. To prevent scar tissue from returning, your doctor may give you estrogen and place a balloon in your uterus for up to a week after surgery. A follow-up hysteroscopy or other method of uterine evaluation may also be needed to determine if scar tissue has returned.

What are the risks of hysteroscopy?


Only 1% of women have complications from an office hysteroscopy.


After any procedure, you could have an infection. Rarely, the
surgeon could accidentally puncture a hole in the wall of your
uterus (called uterine perforation) using the hysteroscope. These
holes are small and usually heal by themselves.


Complications with operative hysteroscopy include absorption
of fluid, infection, bleeding, and uterine perforation. If a perforation
occurs during an operative hysteroscopy, you may need another
procedure to ensure there is no damage to nearby organs such as
your intestines, bladder, or blood vessels.

Thank you to ASRM for creating this fact sheet for patients and allowing us to reprint it here.


Created 2008
© 2008 The American Society for Reproductive Medicine • ASRM grants permission to photocopy this fact sheet and distribute it to patients.

Fertility Society Meeting, Aging Parents, and Dr. Richard Scott Jr.

  
  
  

Good news for those of us pursuing families when our 30’s are just a memory. Dr. Richard Scott, of Reproductive Medicine Associates of New Jersey (and Laboratory and Practice Director of RMACT) , in a lecture presented at ASRM (American Society of Reproductive Medicine), had this to say,Dr. Richard Scott, Jr, MD, HCLD

 "When we counsel our patients, we should tell them that there are significant risks that come with age for pregnancy-induced hypertension, gestational diabetes, preterm delivery, intrauterine growth restriction, and placentation disorders," Dr. Scott said. "However, none of these are of an order of magnitude where we would counsel our patients not to pursue planning for a family."

This comment was made after discussing the risks associated in becoming pregnant and delivering a child slightly later in life. A little disheartening that not only is it more difficult to become pregnant after we have turned 40, it is also more of a risk to carry the baby to term. Dr. Scott also had this to say:

“We don't necessarily understand whether an older woman's maternal environment is intrinsically different at age 48 or age 52 or whether we just see differences in outcomes because she is more likely to have hypertension, diabetes, be overweight or have hypothyroidism,"

Let’s look at the conversation around the age of our eggs and the information that our general health does not necessarily affect the quality. In other words, we can be fit, eating properly, exercising properly, and abstaining from drugs and alcohol and still have eggs that are of poor quality. Not exactly empowering, nor particularly motivating. Then reread the statement above from Dr. Scott. What is encouraging to me in his statement is that here is where how we are caring for ourselves, our bodies, our minds does matter tremendously. If it is not intrinsic that being older when carrying a pregnancy creates a higher risk, than the state of our health does come into play and is something that we can do something about. It’s a reason to make changes in our lifestyles, a way to become proactive in our treatment.

The name of the session we’ve been discussing?  "Wrinkled Parents: Medical, Ethical, and Psychosocial Issues of Parenting at an Older Age." Reported in ASRM news, Andrea Braverman, PhD, also from RMANJ, made this eye opening comment:

"There's more to parenting than just having a pulse," she said. "The thing that we come back to over and over again is not that you just have a pulse but rather how active are you."

Dr. Braverman went on to discuss the advantages as well as the disadvantages of older parents.

Financial considerations that older parents often encounter include balancing conflicting financial demands of saving for college tuition versus retirement savings. Dr. Braverman said social issues for older parents will include the challenges of socializing with parents who may be a decade or two younger and therefore have different life and career demands. Older parents may also approach parenthood with disparate needs with one parent ready for retirement at an earlier age than the other.

Dr. Braverman additionally listed the advantages versus the disadvantages of older parenting. Advantages of older parenting include readiness, maturity, financial stability, and enjoyment, while the disadvantages included lower energy level, social stigma, a generation gap, and lack of a peer group with fellow parents.

This session also included the ethical and even touches upon some of the legal issues involved in treatment for older patients. Judith Daar, JD, discussed some of the restrictions and policy issues.

In addressing the legal and ethical perspectives, Judith F. Daar, J.D., Associate Dean, Whittier Law School, and Clinical Professor, University of California-Irvine School of Medicine said that no federal or state law prohibits delivery of assisted reproductive technology (ART) based on the age of a patient.

Where does this leave us? Why did I choose to write about this, out of all the different aspects being presented at ASRM?

This is the good news. We do get pregnant, that’s why. Despite the statistics being lower and having to use more procedures, we do get pregnant. And we do parent children, even when we don’t become pregnant. We parent children through surrogacy or adoption. So shouldn’t we know what the issues of parenting are past the age of 40?

Infertility Takes Center Stage in Denver at ASRM Annual Meeting

  
  
  

Monday Text
The American Society for Reproductive Medicine (ASRM) American Society of Reproductive Medicine, 2010 Meeting in Denveris having their annual meeting in Denver Colorado this week. The meeting brings together the finest reproductive endocrinologists, scientists, clinicians, administrators, attorneys, nurses and more, in the reproductive health field. ASRM’s annual meeting is an opportunity for the professionals in the reproductive health field to take post-doctorate courses, continuing medical education courses, (CME’s), present oral presentations, papers, posters, and videos for just some of the following topics:

A sample of the topics to be covered includes: steroid hormone action, stem cell research, technological advances in reproductive surgery including robotics and adhesion prevention, effects of appetite and diet on reproduction, gender-specific aspects of cardiovascular disease and impact of infertility diagnoses and therapies, the ethics of cross-border reproductive healthcare, molecular genetics of male and female gametes and the early embryo, medical and public health ramifications of menopause, new innovations in contraception, ovarian stimulation, oocyte and sperm cryopreservation, and integration of medical and psychological care of the couple undergoing reproductive medical care.  

Reading the press releases is a way that I have always found useful to sift through the tremendous amount of information that is both presented at the meeting and released to us, the public. The first press release that I will share with you this week is on a subject that we have been addressing closer to home at Reproductive Medicine Associates of CT with our nutritionist and our Fertility Seminar Series. That subject is obesity and infertility. Read below for ASRM’s press release:

Denver, CO - Two studies released today at the 66th Annual Meeting of the American Society for Reproductive Medicine, shed light on the link between obesity and infertility.

In the first, investigators used the national database collected by the Society for Assisted Reproductive Technology (SART). Examining the 158, 385 cycles where the height and weight of the woman were reported, they found that cycle cancellation rates increased with increasing body mass index (BMI). The odds of the patient failing to become pregnant, or that pregnancy not being successfully carried to term, also rose significantly with increasing obesity.

A team from Harvard and Brigham and Women’s Hospital in Boston sought to explore the reason behind the link between infertility and obesity. In their study they examined the quality of the eggs and embryos from women of different BMI categories. They found that the eggs from women with high and low BMI’s were more likely than other women to produce immature oocytes during an ART cycle. This led to lower odds of successful embryo transfer per retrieval and a lower live birth rate.

“Clearly a healthy body weight is an important advantage in all aspects of health, including reproductive health. We are hoping that with better information we can provide better help to our patients whose struggle with infertility includes a struggle with weight,” said James Goldfarb, MD, President of the Society for Assisted Reproductive Technology (SART).

More to come this week from the ASRM annual meeting. The information that comes out of this annual meeting, whether it is medical breakthroughs, research, scientific data, legal updates, a clearer understanding of the emotional components is always outstanding and sometimes startling. There will be updates on this blog throughout the week.

Who Should Be Able to Access Infertility Treatment?What Does Affordable Mean?

  
  
  

Thursday text
I wrote last week about the cost of infertility treatment and even used the word elitist, which ticked some people off. Very shortly afterwards, I got into a spirited conversation with two of my closest friends about the political, emotional, financial in’s and out’s of infertility coverage in the United States. I was taken aback, frankly, listening to their points of view, and realizing that it was probably representative of the general public.

What I heard is that people without health insurance (that covers treatment), without a state mandate or without substantial financial resources, in essence, are out of luck, as far as they were concerned, about creating their families.

So my mind started jumping around about this and I started looking up information. Here are a few things that I found out.

About insurance, coverage and experimental treatment:

In the past, insurance carriers that do not have exclusions have denied claims for one of the following three reasons: 

1.      Infertility is not an illness;

2.      Treatment of infertility is not medically necessary;

3.      Treatment of infertility is experimental. 

These are invalid reasons to deny your claim. Infertility is an illness (2). Medically necessary is usually defined by insurance policies as medically required and medically appropriate for diagnosis and treatment of an illness or injury under professionally recognized standards of health care. Treatments such as GIFT, IVF, ZIFT/PROST have NOT been on the American Medical Association's experimental list since the late 1980s.

Interesting information above, given that GIFT, ZIFT/PROST have not been options that have been used in infertility treatment for many, many years. This is information from INCIID, (InterNational Council on Infertility Information Dissemination, Inc.) a well respected patient advocacy organization, included in a paper written several years ago. The three reasons cited for non coverage are as true today as they were when this paper is written.

Many roads, in the early 2000’s led to the ADA (Americans with Disabilities ACT). It was felt that if infertility was recognized as a disease that it would be more compelling to have insurance covering it. While that has worked to a certain extent, has the ADA ruling been more helpful in creating state mandates? Currently we have 14 states with state mandated coverage.

From ASRM (American Society for Reproductive Medicine)in their area of patient information. A simple definition of infertility:

Infertility is NOT an inconvenience; it is a disease of the reproductive system that impairs the body's ability to perform the basic function of reproduction.

Under ADA, reproduction has been held by the US Supreme Court to be a major life activity. (In fact, no less important than learning or working.) More about whether or not infertility is considered a disease:

The U. S. Supreme Court held in 1998 that infertility is a disability under the Americans with Disabilities Act (ADA). But the Court subsequently held that a person is not considered disabled under the act if the disability can be overcome by mitigating or corrective measures. And a lower court held in 2000 that, while infertility is a disability, an employer’s health plan that excludes treatment for it is not discriminatory under ADA if it applies to all employees.

It seems to me that infertility is considered a disease, but a somewhat special disease in that treatment is considered optional, or even a life style choice as reported in Newsweek.

Here’s how the article begins:

When doctors at a local St. Louis clinic told Marcie Campbell it would cost more than $15,000 to try to get her pregnant, she was crushed. For somebody with polycystic ovary syndrome, coupled with blocked fallopian tubes, in vitro fertilization was the best option to conceive a child. But with a household income of $47,000 a year, it was hardly an option. (Missouri isn’t one of the 15 states that mandate insurance coverage for IVF.)

“I told them, ‘There’s no way.’ We can’t afford it. Maybe rich folks can,” says Campbell, 33.

It takes me back full circle to the conversation with my friends. Is infertility treatment elitist? Interesting to me that this article reports that this couple was able to afford treatment for $7,500, not $15,000; we all know that some prospective parents, in this economy can’t afford that either.

We don’t dictate to couples without fertility problems how much money they have to have, how far up the corporate ladder they have risen before they start their family. Without infertility, when and how you start a family is entirely within your own discretion and that decision is made in the privacy of your own home. Is someone making minimum wage less able to raise a child? Less able to be a loving parent?

The article continues, pointing out the significant differences between insurance and affordable Infertility treatment here in the US and in Europe.

Whether infertility should be classified as a disease or a socially constructed need is a dilemma at the center of this debate. While most other developed countries consider infertility a medical condition and insurance policies often cover the costs of IVF, health insurers in the U.S. typically don’t think “wanting a child” is a medical necessity.

We don’t value our children less in this country. So what is it? And better yet, going forward, what can we do to ensure that infertility treatment is either covered by insurance, a state mandate, or health care reform?

What can we do to make this a reality?

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