A Public Health Focus on Infertility Prevention, Detection, and Management

Page Four

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Call for Action

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.

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.