The week of Sunday, April 24 through Saturday, April 30 is recognized as National Infertility Awareness Week (NIAW). The week aims to boost awareness that infertility needs and deserves attention. It also aims to establish guidelines for when couples should see a specialist and enlightens lawmakers about how infertility affects people in each state.
NIAW was founded in the year 1989 by Resolve: The National Infertility Association. According to their webpage, their mission is “to empower you and change the conversation around infertility. All too often myths and misinformation appear in media stories or influence lawmakers and companies to enforce policies that create barriers for people who need help building their family. And still people feel isolated when they struggle to build a family. So, we want to empower them to share their story and find a community that cares.”
Even though NIAW was founded in 1989, it did not become a federally recognized health observance until 2010. Resolve.org also reports that one in eight couples (or 12% of married women) have trouble getting pregnant or sustaining a pregnancy. Additional facts provided by resolve.org reveals that 7.4 million women, or 11.9% of women, have ever received any infertility services in their lifetime and that approximately one-third of infertility is attributed to the female partner, one-third attributed to the male partner and one-third is caused by a combination of problems in both partners or is unexplained. Further data revealed that in any given month, couples aged between 29 and 33 with normal function of their reproductive systems only have a 20 to 25% chance of conception and that after six months of trying, 60% of couples will conceive without medical assistance.
Infertility is a very traumatizing event. Even with advances in medicine and science, most simply cannot afford treatment and many insurance companies do not offer fertility coverage in their plans. However, it is noted that 12 states have a mandate that requires qualified employers to provide in-vitro fertilization (IVF) coverage to their employees. Those states are Arkansas, Colorado, Connecticut, Delaware, Hawaii, Illinois, Maryland, Massachusetts, New Hampshire, New Jersey, New York and Rhode Island. Resolve.org said, “The Affordable Care Act (ACA) does not require coverage for infertility treatments. Those states with an infertility mandate that covers IVF may have chosen an Essential Health Benefits (EHB) benchmark plan that includes the IVF mandate. The EHB impacts the individual and small group markets only in each state.” With the facts presented above, one can see why awareness of infertility needs enhanced and deserves attention.
NIAW also aims to provide guidelines one when those experiencing fertility issues should consult with a specialist. Resolve.org provided a list of risk factors for both men and women.
Infertility risk factors for women:
The following are factors which can affect your ability to ovulate, conceive, or carry a pregnancy to term:
• excessive, or very low, body fat can affect ovulation and fertility
• chronic diseases, such as diabetes, hyper or hypothyroidism, lupus, arthritis, hypertension or asthma—tell your doctor about prescription medicines that you are currently taking
• abnormal pap smears which have resulted in treatment such as cryosurgery or cone biopsy
• your mother took DES when she was pregnant with you — tell your doctor so an x-ray can be done to assess the size and shape of your uterus
• hormonal imbalance—periods exceeding six days, cycles shorter than 24 days or more than 35 days apart; irregular, unpredictable cycles, very heavy periods, excessive facial hair or acne on face, chest, abdomen
• multiple miscarriages—two or more early pregnancy losses
• environmental factors—cigarette smoking or alcohol consumption, exposure to workplace hazards or toxins
Even if your fertility does not seem at risk now, remember that fertility declines with age. A woman in her late 30s is about 30% less fertile than she was in her early 20s. See your doctor if you are over 30 and have been trying to conceive for six months or more.
Twelve million cases of newly diagnosed STDs occur in the USA annually, with one quarter of those acquired by teenagers. Some STDs can be asymptomatic. They are transmitted more easily to women, and can lead to pelvic inflammatory disease (PID) in women, and epididymitis in men. Complications are more common in women, including subsequent scarring, miscarriage, adhesions, blocked tubes and ectopic pregnancy. Ultimately, infertility can be a consequence of STDs.
To decrease this risk, consider that people in mutually monogamous relationships with an uninfected partner have the lowest risk of getting an STD, use latex condoms for contraception and detect and treat infections early. Both partners should be treated simultaneously if one has an infection
Fallopian tube disease accounts for about 20% of infertility cases treated.
If you are having trouble conceiving, or are worried about your future fertility, be sure to tell your doctor if you have had:
• STDs, such as gonorrhea, syphilis, or chlamydia, pelvic pain, unusual vaginal discharge, bleeding or fever, pelvic surgery for ruptured appendix, ectopic pregnancy or ovarian cyst
• An IUD for contraception
• Two or more abortions
Remember, use of a condom can be effective in preventing the spread of STDs. If you have an infection, your partner must be treated also. A specialist can assess the health of your uterus and tubes with an x-ray known as a hysterosalpingogram (HSG).
Endometriosis is a disease in which uterine tissue is found outside of the uterus, on the ovaries, fallopian tube and often on the bladder and bowel. It can occur in menstruating women of all ages, including teens. While the connection between endometriosis and infertility is not clearly understood, early detection may result in successful control and preservation of fertility.
Be sure to report these symptoms to your doctor:
• Painful menstrual cramps that may be worsening with time extremely heavy menstrual flow
• Diarrhea or painful bowel movements, especially around your period
• Painful sexual intercourse
Endometriosis runs in families, so it is important to tell your doctor if your mother or sisters had symptoms or were diagnosed with the disease. It may be symptom-less, however, and diagnosis may only be confirmed with an outpatient surgery known as laparoscopy.
Infertility risks for men:
Infertility is not solely a women’s problem. About 30% of infertility cases involve male factor problems alone, and 30% of cases involve problems with both partners. Many researchers believe the causes of declining male fertility during this century are environmental; they include pesticide and chemical exposure, drug use, radiation and pollution.
The following is a partial list of environmental risk factors to male fertility:
• Exposure to toxic substances or hazards on the job, such as lead, cadmium, mercury, ethylene oxide, vinyl chloride, radioactivity and x-rays
• Cigarette or marijuana smoke, heavy alcohol consumption
• Prescription drugs for ulcers or psoriasis
• DES exposure in utero
• Exposure of the genitals to elevated temperatures — hot baths, whirlpools, steam rooms
Medical risks to male fertility include:
• Hernia repair
• Undescended testicles
• History of prostatitis or genital infection
• Mumps after puberty
Finally, lawmakers need to be aware of the impact infertility has on those that suffer from it. Infertility does not discriminate and those who want to have a family are often prevented from being able to simply because they have no insurance coverage. Resolve.org provides current legislation that would require medical insurance providers to offer infertility services. West Virginia currently has a bill known as HB 4803 that aims to do just that. The bill was introduced on Tuesday, February 15 by Delegate Young. Unfortunately, the bill was referred to House, Banking, and Insurance Committee. Bill did not move forward before end of session and remains in Committee until 2023 session. The bill can be viewed in its entirety by logging on to wvlegislature.gov.
Some ways to honor NIAW include educating yourself on infertility including things to say and things to not say to those experiencing the pain of infertility. Ivfga.com also said, “Remember that infertility is a disease. Just like any other condition, treatment often takes time, and there is rarely a one-size-fits-all solution. Showing sympathy for the false starts and setbacks your friends or family members may experience can help them stay hopeful. While the challenges of infertility can build walls between people, it does not have to. You can help bring those walls down, a few kind words and supporting actions at a time. Genuinely trying to relate to your close friends’ and family members’ experiences can strengthen your relationships with them and may even help you gain a better understanding of the effects of this too-often misunderstood condition.”