Fertility Treatment
Infertility is a condition with unique and profound psychological and emotional impacts. Infertility is experienced by most couples as a life crisis in which they feel isolated and powerless. Feelings of frustration, anger, depression, grief, guilt, and anxiety are common and should be anticipated and dealt with appropriately. [ACOG Technical Bulletin 125. Infertility. February 1989.]
The treatment of infertility poses many controversial issues, ranging from religious objections to questions of fraudulent inducement by unscrupulous fertility clinics that misrepresent their actual success rate. Infertility treatment has become a big business as the number of couples defined as infertile has increased. Some of this increase is related to the increased age at which many women attempt to conceive their first child. This delay shortens the period available to have children. Women who might have conceived by age 35 if they had begun trying to have children at age 20 are out of time if they start trying to conceive at age 35. Modern birth control methods allow women to be sexually active without becoming pregnant. This increases the probability that the woman will suffer complications of a sexually transmitted disease (STD) that will impair her fertility. Perhaps the greatest increase in infertile couples has come from a more liberal definition of infertility.
Current statistics indicate that more than 14% of couples who desire a child are unable to conceive within a year. [ACOG Technical Bulletin 120. Medical Induction of Ovulation. September 1988.] It is recommended that fertility treatment not be started (in the absence of a specific problem) until the couple have tried to conceive without using birth control for one year. [ACOG Technical Bulletin 142. Male Infertility. June 1990.] This is considered a conservative time period and was recommended because some fertility clinics were beginning treatment only a few months after a couple had begun to try to conceive. In earlier periods, however, a couple would not see themselves as having a medical problem until they had tried to conceive for several years. It is impossible to know how many of the 14% who did not conceive in a year would eventually conceive without intervention. Thus, it is impossible to determine what component of the infertility epidemic represents changed expectations and the ready availability of fertility services for those able to pay for them.