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Call for Action

Acknowledgements

References

Appendix

Current Public Health Efforts Addressing Infertility at the CDC

The CDC will strengthen its effort to address infertility by engaging other federal agencies, professional and consumer organizations, industry, and the community at large in the development of a national public health plan for the prevention, detection, and management of infertility. The findings and recommendations contained in this article can serve as a platform to stimulate discussion. The national plan will identify public health priorities and recommend integration of existing programs and initiatives, as well as creation of new programs as deemed necessary. It will also outline plans for promoting the necessary changes in law and policies, in public health surveillance and research, and in the organization and financing of public health programs and health care systems. As a first step, the CDC invited potential partners from the public, private, and nonprofit arenas to participate in a Public Health Symposium on Infertility held in Atlanta on September 15–16, 2008. About 60 individuals from federal agencies, organizations representing local public health agencies, professional organizations, consumer organizations and other NGOs attended the meeting. The symposium ended with a collective intent to continue the conversation, form working groups on specific topics, and develop a draft national action plan.

Acknowledgments

The authors thank the CDC-wide Infertility Working Group (Judy Berkowitz, Stuart Berman, Renee Brown-Bryant, Kelly Brumbaugh, Anjani Chandra, Byram Clayton, Aldolfo Correa, Sherry Farr, Suzanne Folger, Yvonne Green, Harriet Jett, Robert Johnson, Muin Khoury, John Lehnherr, Maurizio Macaluso, Loria Pollack, Samuel Posner, Amy Pulver, Catherine Satterwhite, Laura Schieve, Mithi Sunderam, Katrina Trivers, Richard Wang, Lee Warner, Hannah Weir, Maura Whiteman, Victoria Wright, Tracie Wright-Schnapp) for their contribution.

References

1. S.J. Ventura, Trends and variations in first births to older women, United States, 1970–1986, Vital Health Stat 1989 21(47):1–27.
2. B.E. Hamilton, J.A. Martin and S.J. Ventura, Births: preliminary data for 2006, Natl Vital Stat Rep 2007;56:18.
3. American Society for Reproductive Medicine. Definition of “infertility,” Fertil Steril  2006;86:S228.
4. Bragdon v. Abbott, 524 U.S. 624 (1998).
5. A. Chandra, G.M. Martinez, W.D. Mosher, J.C. Abma and J. Jones, Fertility, family planning, and reproductive health of U.S. women: data from the 2002 National Survey of Family Growth, Vital Health Stat 2005;23:1–160.
6. G.M. Martinez, A. Chandra, J.C. Abma, J. Jones and W.D. Mosher, Fertility, contraception, and fatherhood: data on men and women from cycle 6 (2002) of the 2002 National Survey of Family Growth, Vital Health Stat 2006;23(26):1–142.
7. E.H. Stephen and A. Chandra, Declining estimates of infertility in the United States: 1982–2002, Fertil Steril 2006;86:516–523.
8. L.A. Schieve, S.F. Meikle, C. Ferre, H.B. Peterson, G. Jeng and L.S. Wilcox, Low and very low birth weight in infants conceived with use of assisted reproductive technology, N Engl J Med 2002;346:731–737.
9. Wellons MF, Lewis CE, Schwartz SM, Gunderson EP, Schreiner PJ, Sternfeld B, et al. Racial differences in self-reported infertility and risk factors for infertility in a cohort of black and white women: the CARDIA Women's Study. Fertil Steril. In press.
10. M.M. Peterson, Assisted reproductive technologies and equity of access issues, J Med Ethics 2005;31:280–285.
11. Centers for Disease Control and Prevention, Society for Assisted Reproductive Technology. 2004 Assisted Reproductive Technology Success Rates: National Summary and Fertility Clinic Reports, Department of Health and Human Services, Centers for Disease Control and Prevention, 2006.
12. D. Scholes, A. Stergachis, F.E. Heidrich, H. Andrilla, K.K. Holmes and W.E. Stamm, Prevention of pelvic inflammatory disease by screening for cervical chlamydial infection, N Engl J Med 1996;334:1362–1366.
13. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2006 Supplement, Chlamydia Prevalence Monitoring Project Annual Report 2006, Department of Health and Human Services, Centers for Disease Control and Prevention, 2007.
14. R.B. Meacham, G.F. Joyce, M. Wise, A. Kparker and C. Niederberger, Male infertility, J Urol 2007;177:2058–2066
15. J.L.H. Evers and J.A. Collins, Assessment of efficacy of varicocele repair for male subfertility: a systematic review, Lancet 2003;361:1849–1852.
16. S.H. Swan, E.P. Elkin and L. Fenster, The question of declining sperm density revisited: an analysis of 101 studies published 1934-1996, Environ Health Perspect  2000;108:961–966.
17. W.J. Moorman, H.W. Ahlers, R.E. Chapin, G.P. Daston, P.M. Foster and R.J. Kavlock et al., Prioritization of NTP reproductive toxicants for field studies, Reprod Toxicol 2000;14:293–301. 
18. C.C. Lawson, B. Grajewski, G.P. Daston, L.M. Frazier, D. Lynch and M. McDiarmid et al., Workgroup report: implementing a national occupational reproductive research agenda—decade one and beyond, Environ Health Perspect 2006;114:435–441.
19. C. Augood, K. Duckitt and A.A. Templeton, Smoking and female infertility: a systematic review and meta-analysis, Hum Reprod 1998;13:1532–1539.
20. J.E. Nestler, J.N. Clore and W.G. Blackard, The central role of obesity (hyperinsulinemia) in the pathogenesis of the polycystic ovary syndrome, Am J Obstet Gynecol 1989;161:1095–1097.
21. Office of the Surgeon General. Office on Smoking and Health. The Health Consequences of Smoking: a Report of the Surgeon General, U.S. Department of Health and Human Services, Public Health Service, 2004.
22. H. Klonoff-Cohen, L. Natarajan, R. Marrs and B. Yee, Effects of female and male smoking on success rates of IVF and gamete intra-Fallopian transfer, Hum Reprod  2001;16:1382–1390.
23. K.M. Curtis, D.A. Savitz and T.E. Arbuckle, Effects of cigarette smoking, caffeine consumption, and alcohol intake on fecundability, Am J Epidemiol 1997;146:32–41.
24. G.C. Windham, E.P. Elkin, S.H. Swan, K.O. Waller and L. Fenster, Cigarette smoking and effects on menstrual function, Obstet Gynecol 1999;93:59–65.
25. A. Kinney, J. Kline and B. Levin, Alcohol, caffeine and smoking in relation to age at menopause, Maturitas 2006;54:27–38.
26. S.M. McKinlay, N.L. Bifano and J.B. McKinlay, Smoking and age at menopause in women, Ann Intern Med 1985;103:350–356.
27. M.F. Vine, C.K. Tse, P. Hu and K.Y. Truong, Cigarette smoking and semen quality, Fertil Steril 1996;65:835–842.
28. S.F. Dorfman, Tobacco and fertility: our responsibilities, Fertil Steril 2008;89:502–504.
29. American Society for Reproductive Medicine, Smoking and infertility, Fertil Steril 2006;86:S172–177.
30. R. Pasquali, L. Patton and A. Gambineri, Obesity and infertility, Curr Opin Endocrinol Diabetes Obes 2007;14:482–487.
31. S.S. Kim, Fertility preservation in female cancer patients: current developments and future directions, Fertil Steril 2006;85:1–11.
32. R.A. Lobo, Potential options for preservation of fertility in women, N Engl J Med 2005;353:64–73.
33. C. Sklar, Maintenance of ovarian function and risk of premature menopause related to cancer treatment, J Natl Cancer Inst Monogr 2005;25–27.
34. M.F.M. Mitwally, Fertility preservation and minimizing reproductive damage in cancer survivors, Expert Rev Anticancer Ther 2007;7:989–1001.
35. L. Waters, C. Gilling-Smith and F. Boag, HIV infection and subfertility, Int J STD AIDS 2007;18:1–6.
36. American Society for Reproductive Medicine, Human immunodeficiency virus and infertility treatment, Fertil Steril 2004;82(Suppl 1):S228–231.
37. A.B. Coffield, M.V. Maciosek, J.M. McGinnis, J.R. Harris, M.B. Caldwell and S.M. Teutsch et al., Priorities among recommended clinical preventive services, Am J Prev Med 2001;21:1–9.
38. M.V. Maciosek, A.B. Coffield, J.M. McGinnis, J.R. Harris, M.B. Caldwell and S.M. Teutsch et al., Methods for priority setting among clinical preventive services, Am J Prev Med 2001;21:10–19.
39. Vahratian A. Utilization of fertility-related services in the United States. Fertil Steril. In press.
40. Centers for Disease Control and Prevention. 2005 Assisted Reproductive Technology Success Rates Report.
41. M.A. Reynolds, L.A. Schieve, J.A. Martin, G. Jeng and M. Macaluso, Trends in multiple births conceived using assisted reproductive technology, United States, 1997-2000, Pediatrics 2003;111:1159–1162.
42. M. Griffin and W.F. Panak, The economic cost of infertility-related services: an examination of the Massachusetts infertility insurance mandate, Fertil Steril 1998;70:22–29.
43. E.G. Hughes, The effectiveness of ovulation induction and intrauterine insemination in the treatment of persistent infertility: a meta-analysis, Hum Reprod 1997;12:1865–1872.
44. B.J. Van Voorhis, Outcomes from assisted reproductive technology, Obstet Gynecol 2006;107:183–200.
45. American Society for Reproductive Medicine, Ovarian hyperstimulation syndrome, Fertil Steril 2006;86:S178–183.
46. The ESHRE Capri Workshop Group, Multiple gestation pregnancy, Hum Reprod 2000;15:1856–1864.
47. M.V. Senat, P.Y. Ancel, M.H. Bouvier-Colle and G. Breart, How does multiple pregnancy affect maternal mortality and morbidity?, Clin Obstet Gynecol 1998;41:78–83.
48. J.L. Kiely, What is the population-based risk of preterm birth among twins and other multiples?, Clin Obstet Gynecol 1998;41:3–11.
49. R. Klemetti, M. Gissler and E. Hemminki, Comparison of perinatal health of children born from IVF in Finland in the early and late 1990s, Hum Reprod 2002;17:2192–2198.
50. M. Dhont, P. De Sutter, G. Ruyssinck, G. Martens and A. Bekaert, Perinatal outcome of pregnancies after assisted reproduction: a case-control study, Am J Obstet Gynecol 1999;181:688–695.
51. P.O. Pharoah, Risk of cerebral palsy in multiple pregnancies, Clin Perinatol 2006;33: 301–313.
52. F.M. Helmerhorst, Perinatal outcome of singletons and twins after assisted conception: a systematic review of controlled studies, BMJ 2004;328:261.
53. R.A. Jackson, K.A. Gibson, Y.W. Wu and M.S. Croughan, Perinatal outcomes in singletons following in vitro fertilization: a meta-analysis, Obstet Gynecol 2004;103:551–563.
54. L.A. Schieve, C. Ferre, H.B. Peterson, M. Macaluso, M.A. Reynolds and V.C. Wright, Perinatal outcome among singleton infants conceived through assisted reproductive technology in the United States, Obstet Gynecol 2004;103:1144–1153
55. M. Henman, J.W. Catt, T. Wood, M.C. Bowman, K.A. de Boer and R.P. Jansen, Elective transfer of single fresh blastocysts and later transfer of cryostored blastocysts reduces the twin pregnancy rate and can improve the in vitro fertilization live birth rate in younger women, Fertil Steril 2005;84:1620–1627.
56. H.G. Lukassen, D.D. Braat, A.M. Wetzels, G.A. Zielhuis, E.M. Adang and E. Scheenjes et al., Two cycles with single embryo transfer versus one cycle with double embryo transfer: a randomized controlled trial, Hum Reprod 2005;20:702–708.
57. A. Thurin, J. Hausken, T. Hillensjo, B. Jablonowska, A. Pinborg and A. Strandell et al., Elective single-embryo transfer versus double-embryo transfer in in vitro fertilization, N Engl J Med 2004;351:2392–2402.
58. D.K. Gardner, E. Surrey, D. injarez, A. Leitz, J. Stevens and W.B. Schoolcraft, Single blastocyst transfer: a prospective randomized trial, Fertil Steril 2004;81:551–555. 
59. A.T. Kjellberg, P. Carlsson and C. Bergh, Randomized single versus double embryo transfer: obstetric and paediatric outcome and a cost-effectiveness analysis, Hum Reprod 2006;21:210–216.
60. A.A. Fiddelers, A.P. van Montfoort, C.D. Dirksen, J.C. Dumoulin, J.A. Land and G.A. Dunselman et al., Single versus double embryo transfer: cost-effectiveness analysis alongside a randomized clinical trial, Hum Reprod 2006;21:2090–2097.
61. E.C. Feinberg, F.W. Larsen, W.H. Catherino, J. Zhang and A.Y. Armstrong, Comparison of assisted reproductive technology utilization and outcomes between Caucasian and African American patients in an equal-access-to-care setting, Fertil Steril 2006;85:888–894
62. American Society for Reproductive Medicine. Frequently asked questions about infertility (question 6). Available at: http://www.asrm.org/Patients/faqs.html.* Accessed February 22, 2008.
63. P. Katz, R.D. Nachtigall and J. Showstack, The economic impact of the assisted reproductive technologies, Nat Cell Biol  2002;4:S29.
64. A.T. Fidler and J.J. Bernstein, Infertility: from a personal to a public health problem, Public Health Rep 1999;114:494–511.
65. J. Farley Ordovensky Staniec and N.J. Webb, Utilization of infertility services: how much does money matter?, Health Serv Res 2007;42:971–989.
66. T.E. Roberts, S. Robinson, P.M. Barton, S. Bryan, A. McCarthy and J. Macleod et al., Cost effectiveness of home based population screening for Chlamydia trachomatis in the UK: economic evaluation of chlamydia screening studies (ClaSS) project, BMJ 2007;335:291.
67. D. Hu, E.W. Hook 3rd and S.J. Goldie, Screening for Chlamydia trachomatis in women 15 to 29 years of age: a cost-effectiveness analysis, Ann Intern Med 2004;141:501–513.
68. J.M. Yeh, E.W. Hook 3rd and S.J. Goldie, A refined estimate of the average lifetime cost of pelvic inflammatory disease, Sex Transm Dis 2003;30:369–378.
69. T. Nyari, C. Nyari, M. Woodward, G. Meszaros, J. Deak and E. Nagy et al., Screening for Chlamydia trachomatis in asymptomatic women in Hungary. An epidemiological and cost-effectiveness analysis, Acta Obstet Gynecol Scand 2001;80:300–306.
70. M.J. Postma, A. Bakker, R. Welte, J.E. van Bergen, J.A. van den Hoek and L.T. de Jong-van den Berg, et al., [Screening for asymptomatic Chlamydia trachomatis infection in pregnancy; cost-effectiveness favorable at a minimum prevalence rate of 3% or more, Ned Tijdschr Geneeskd 2000;144:2350–2354.
71. R.D. Nachtigall, International disparities in access to infertility services, Fertil Steril 2006;85:871–875.
72. S.O. Rutstein and I.H. Shah, Infecundity, Infertility, and Childlessness in Developing Countries, DHS Comparative Reports, ORC Macro and the World Health Organization, 2004.
73. B.J. Anderson, M. Macaluso and L.S. Wilcox, Reproductive health. In: R.A. Goodman, R.E. Hoffman, W. Lopez, G.W. Matthews, M. Rothstein and K. Foster, Editors, Law In Public Health Practice, Oxford University Press, New York 2006;452–477.
74. The President's Council on Bioethics. Reproduction and responsibility. The regulation of new biotechnologies, President's Council on Bioethics, 2004.

Appendix

Current Public Health Efforts Addressing Infertility at the CDC
The National Center for Birth Defects and Developmental Disabilities studies the links between infertility treatment and birth defects (in the National Birth Defects Prevention Study), infertility treatment and neurodevelopmental outcomes (using registry data from Denmark), and infertility treatment and autism (through the Study to Explore Early Development).

The National Center for Chronic Disease Prevention and Health Promotion maintains the National ART Surveillance System and publishes the Annual ART Success Rates Report; maintains the Pregnancy Risk Assessment Monitoring System, which collects state-specific, population-based data on maternal attitudes and experiences before, during, and shortly after pregnancy; collaborates with state health departments in the evaluation of adverse outcomes of ART; and conducts research on the effectiveness and safety of ART and on the link between infertility and chronic disease. It also implements the National Action Plan for Cancer Survivorship: Advancing Public Health Strategies, which specifically mentions infertility as a concern of cancer survivors, and recognizes the need for fertility preservation in this group.

The National Center for Environmental Health maintains the National Biomonitoring Program, which evaluates people's environmental exposures by measuring toxic substances or their metabolites in human specimens and publishes The National Report on Human Exposure to Environmental Chemicals . The National Center for Environmental Health also improves the technology for laboratory testing of steroid hormones to facilitate research and clinical assessment of conditions leading to infertility, and carries out research on the impact of pesticides, hormonally active agents, and other environmental exposures on reproduction.

The National Center for Health Statistics conducts the National Survey of Family Growth (NSFG), which gathers information on family life, marriage and divorce, pregnancy, infertility, use of contraception, and men's and women's health. The NSFG is the only population-based source of information on the prevalence of infertility and receipt of infertility services other than ART. The National Center for Health Statistics also maintains the National Vital Statistics System. The 2003 revision of the birth certificate includes questions on infertility treatment in the risk factors section. As of today, 19 states have incorporated these questions in their birth certificate.

The National Center for HIV/AIDS, Hepatitis, Sexually Transmitted Diseases and Tuberculosis Prevention supports the National Infertility Prevention Program, which funds and coordinates chlamydia screening and treatment services for low-income, sexually active young women attending family planning, STD, and other women's health care clinics. In addition, the Center supports prevention of gonorrhea, another important cause of PID, develops and publishes guidelines that identify the most effective STD treatments, monitors rates of these PID-causing infections, and facilitates treatment of sexual partners exposed to infection.

The National Institute of Occupational Safety and Health has developed and implements the National Occupational Research Agenda, which includes a reproductive health component and carries out specific research on workplace hazards that may have effects on reproduction, including studies on cohorts of employees exposed to specific chemicals (boron, phthalates, Bisphenol-A, 1- and 2-bromopropane, methoxychlor, pesticides) and studies on the reproductive health of working men and women. The National Institute of Occupational Safety and Health also participates in the National Birth Defects Prevention Study, which studies the link between parental exposure and child outcomes.

R.Y.W. has a financial interest in Merck and Pfizer. M.M. has nothing to disclose. T.J.W.-S. has nothing to disclose. A.C. has nothing to disclose. R.J. has nothing to disclose. C.L.S. has nothing to disclose. A.P. has nothing to disclose. S.M.B. has nothing to disclose. S.L.F. has nothing to disclose. L.A.P. has nothing to disclose.

The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

*To compute a preliminary estimate of these costs, we used the annual numbers of infertility visits and non-ART treatment procedures estimated by the NSFG, the annual number of male infertility visits and ambulatory surgery visits for varicocele estimated by Meacham et al. (9), and the number of ART cycles registered in the NASS, the average costs per non-ART infertility treatment procedure reported in a large commercial database (Medstat; Thomson Reuters, New York, NY), and the estimate of the cost for ART cycles published by the ASRM. We also assumed that the number and distribution of term and preterm live-born infants were the same for ART and non-ART infertility treatment and applied the total medical care costs during the first 5 years of life associated with preterm and non-preterm live-born children estimated by the Institute of Medicine (40)Centers for Disease Control and Prevention. The 2005 assisted reproductive technology success rates report. Accessed October 10, 2007.

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Page last reviewed: 4/17/09
Page last modified: 4/17/09
Content source: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion