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Infertility -- United States, 1982

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

  1. 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.

  2. 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.

  3. Aral SO, Cates W Jr. The increasing concern with infertility. Why now? JAMA 1983;250:2327-31.

  4. 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.

  5. Mosher WD. Special tabulation from National Survey of Family Growth, Cycle III. Personal communication, January 11, 1985.

  6. DeCherney AH, Berkowitz GS. Female fecundity and age. N Engl J Med 1982;306:424-6.

  7. Schwartz D, Mayaux BH. Female fecundity as a function of age. N Engl J Med 1982;306:404-6.

  8. Bongaarts J. Infertility after age 30: a false alarm. Fam Plann Perspect 1982;14:75-8.

  9. Hogue CJR, Mollenkamp M. The increasing concern with infertility (Letter). JAMA 1984;252:208.

  10. Frantzen C, Schlosser H-W. Microsurgery and postinfectious tubal infertility. Fertil steril 1982;38:397-402.

  11. 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.

  12. Sherris JD, Fox G. Infertility and STD: a public health challenge. Pop Reports 1983;L:114-51.

  13. 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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