(INCIID) Infertility

INFERTILITY

Infertility strikes many couples today. At a rate of five million couples annually coping with infertility issues of those, only twenty percent will get definitive treatment (INCIID). The reason for this is that many health insurance companies do not cover infertility treatment. Many health insurance plans do not cover the diagnosis and treatment of infertility. In New York, insurers are required to cover diagnoses and treatments of correctable medical conditions. They cannot exclude coverage just because the medical condition results in infertility. Insurance companies, however, are not required to cover certain procedures such as in vitro fertilization. Insurance plans must cover infertility drugs as long as they are approved by the FDA for the diagnosis and treatment of infertility (Mulder, 2006).

About one of every six to eight marriages is infertile; in about 60 percent of these marriages, the infertility is due to female sterility. Occasionally, no abnormality can be discovered in the female genital organs, in which case it must be assumed that the infertility is due either to abnormal physiologic function of the genital system or to abnormal genetic development of the ova themselves (Guyton & Hall, 2000). Statistics indicate that 3.5 million couples in the United States are infertile (Baldo, 2004). In other words, 15% of all couples will experience the frustration of infertility at some point in their relationship.

One of the reasons for infertility is age. Many couples are waiting to get married till much later in life compared with a few decades ago. People used to get married right out of high school, now with women having their own careers that require more education. Many couples are waiting to get married so they can get their education out of the way and establish a career path for themselves. Couples a few decades ago might have been in their early twenties to get married, today wait till their late twenties - early thirties to decide to settle down. Doing this cuts down considerably the likelihood they will be able to have children of their own.

Probably the most common cause of female sterility is failure to ovulate. This can result from hyposecretion of gonadotrophic hormones, in which case the intensity of the hormonal stimuli simply is not sufficient to cause ovulation; or it can result from abnormal ovaries that will not allow ovulation (Guyton & Hall, 2000).

Because of the high incidence of anovulation in sterile women, special methods are often used to determine whether ovulation occurs. These methods are mainly based on the effects of progesterone on the body, because the normal increase in progesterone secretion usually does not occur during the latter half of anovulatory cycles. In the absence of progesteronic effects, the cycle can be assumed to be anovulatory (Guyton & Hall, 2000).

One of these tests is simply to analyze the urine for a surge in pregnanediol, the end product of progesterone metabolism, during the latter half of the sexual cycle, the lack of which indicates failure of ovulation. Another common test is for woman to chart her body temperature throughout the cycle. Secretion of progesterone during the latter half of the cycle raises the body temperature about 0.5°F, the temperature rise coming abruptly at the time of ovulation (Marieb, 2004).

Female infertility is much harder to treat and also does not have the same success rate to be treated as with male infertility. A woman can face various health problems that make her not able conceive or the inabilities to carry to term.

One of the most common causes of female sterility is endometriosis, a common condition in which endometrial tissue almost identical to that of the normal uterine endometrium grows and even menstruates in the pelvic cavity surrounding the uterus, fallopian tubes, and ovaries (Guyton & Hall, 2000).

Another common cause of female infertility is salpingitis, that is, inflammation of the fallopian tubes; this causes fibrosis in the tubes, thereby occluding them. In the past, such inflammation was extremely common as a result of gonococcal infection, but with modern therapy, this is becoming a less prevalent cause of female infertility (Guyton & Hall, 2000).

Still another cause of infertility is secretion of abnormal mucus by the uterine cervix. Ordinarily, at the time of ovulation, the hormonal environment of estrogen causes secretion of mucus with special characteristics that allow rapid mobility of sperm into the uterus and actually guide the sperm up along mucus "threads." Abnormalities of the cervix itself, such as low-grade infection or inflammation, or abnormal hormonal stimulation of the cervix, can lead to a viscous mucus plug that prevents fertilization (Guyton & Hall, 2000).

In the males, the seminiferous tubular epithelium can be destroyed by a number of diseases. For instance, bilateral orchitis of the testes resulting from mumps causes sterility in some affected males. Also, many male infants are born with degenerate tubular epithelia as a result of strictures in the genital ducts or other abnormalities. Finally, another cause of sterility, usually temporary, is excessive temperature of the testes.

Male fertility depends upon adequate production of spermatozoa by the testes, unobstructed transit of sperm through the seminal tract, and satisfactory deposition within the vaginal vault. The history may suggest childhood cryptochordism, mumps orchitis, or a sexual problem that precludes proper deposition of sperm (Marieb, 2004).

In the evaluation of women, normal ovarian function must be established first. Once it is established that ovulation occurs regularly, the reproductive tract should be investigated for functional and anatomic competence to permit union of sperm and ovum in the fallopian tubes (Marieb, 2004).

When no abnormalities are found, reassurance and education of the patient are frequently helpful. Anatomic abnormalities of the cervix or hostile mucus resulting from erosions, infections, and other local disorders should be treated specifically.

There are many treatments for infertility but couples have to consider the cost of a procedure against its success rate, and the time and energy expended. The first step is to choose a physician with clinical expertise in reproductive medicine - a fertility specialist. It is also important that the couple feels comfortable with the fertility specialist of their choice, that he or she expresses an ability to listen to and understand the couple's issues and concerns, one who communicates openly about the couple's options, and most importantly, one whom the couple can feel they can talk to and work with even under stress (Kaur, 2004).

The high incidence of infertility almost guarantees that the complex emotional roller coaster related to infertility that individuals and couples face will be an issue in some facet of their counseling. The problem of infertility affects many couples; therefore, it may be helpful for clinicians to understand the history behind some of the feelings and attitudes related to infertility (Baldo, 2004).

For many couples, the experience of their infertility is quite isolating and lonely. They feel misunderstood and believe that they lack understanding from most of their friends and family members. The couple may not only feel misunderstood, they may also have intense feelings of jealousy and anger toward others who have achieved a successful pregnancy or are celebrating the birth of their biological baby (Baldo, 2004). This only shows that couples who are unable to conceive must also undergo counseling.

Couples are striving to overcome infertility through the many major advances that have come up in the field of medicine. Some couples though would prefer to conceive the natural way and not through in vitro fertilization or other new methods in conceiving and getting pregnant. After all, the old-fashioned method of human reproduction is generally effective for making new people.