The Definition of Infertility

by Charles Kingsland MD, Chief Medical Officer

Birth Control could arguably be described as one of the greatest medical breakthroughs affecting society ever.

Before women were able to control their own reproductive capacity, their lives were dominated by pregnancy, childbirth, miscarriage, breastfeeding, and infant death.

Birth control granted women a level of freedom like never before: the freedom to expand their roles in society past those of wife and mother. The introduction of reproductive agency was closely followed by the widespread availability of education, the vote, and a more dominant appearance of women in the workplace. It changed the world.

Along with this shift in the roles of women in society has come a trend of many women choosing to delay childbearing to later years.?

At the turn of the twentieth century, a woman would normally have her first child under the age of 20 years old.

Last year in the United Kingdom, the average age had risen to 31 years old (US is 27 years old).

What hasn’t changed over this time, however, is human egg viability; as a woman ages, so do her eggs and as a consequence, their ability to fertilize and turn into healthy babies.

Deterioration is rapid over the age of 35, and by the age of forty, as many as one in two women are not just infertile, but sterile.

This is the single most important factor in the rapidly increasing rates of infertility, namely the inability to achieve a successful pregnancy at the time in life that many women would prefer.

Other factors such as increasing rates of obesity, declining sperm counts, and sexually transmitted diseases affecting the genital tract are less common but, nevertheless, important causes.

The definition of Infertility has remained unaltered for decades despite these changes in societal behavior. This changed recently when the American Society of Reproductive Medicine (ASRM) published new guidelines.?

New guidelines advise that couples should consider evaluation of their fertility status if they have been having regular sexual intercourse with no known etiological factors, and the following applies:?

1. The woman is under thirty five years of age and has been unable to conceive after 12 months.
2. The woman is over thirty five years of age and has been unable to conceive after six months.?

This represents a significantly shorter timespan than previous definitions.

It’s interesting to compare timelines of infertility evaluation with those of birth control.

If one wants contraceptive advice, accessibility, certainly in the United Kingdom is immediate, and advice in plentiful supply– mostly as a National Health Service provision.

With Infertility, one is expected to wait, often for a very long time.

Anyone who has suffered the pain and frustration of infertility will know too well the stress and anxiety this can cause. Treatment is also, for most, difficult to find. NHS funding in the UK remains generally poor despite national guidelines advising to the contrary. Waiting times can be up to two years - a period in which many patients unfortunately transition from being infertile to sterile.?

Such delays means that patients often have to resort to funding treatment themselves which is expensive, exorbitantly so in the United States.

The inability to create children at a time when you want to can quickly become all consuming, with profound physical, psychological and sociopolitical consequences not only for the patients but for the immediate family and society as a whole.

For these reasons, it’s time to reevaluate the accessibility and cost of fertility therapies like In Vitro Fertilization, which can be highly successful if used in the right place at the right time.

Why wait for a year– or even six months– when one is debilitated by the fear of childlessness?

For every cycle that passes, eggs get older and the chance of a successful outcome recedes.

What’s needed is effective, accessible, and affordable advice and treatment at a time when a patient needs it, not dissimilar to other recognized disease processes or even family planning.

We at Conceivable Life Sciences welcome the new definition which shortens the timespan and goes some way to address the societal changes that have occurred over the past decades.

Conceivable is well into the process of developing a fully automated IVF laboratory utilizing the latest Robotic technology bringing scalability and accessibility of IVF to patients seeking fertility treatment.