Is Infertility Really a Disease?
We received the following comment on one of my blogs where I referred to infertility as a disease: “I have an issue with infertility described as a ‘disease.’ I honestly do not consider myself diseased. It also seems to imply one root cause, and the causes of infertility are so varied that it seems almost misleading. What am I missing?” The commenter is not alone in questioning if infertility really is a disease, and the answer involves medicine, ethics, politics, and of course, money.
Do you remember back in middle school when you started every paper with a quote from the dictionary? Well, forgive me for my regression, but let’s begin with a medical definition.
Disease /dis·ease: Any deviation from or interruption of the normal structure or function of any body part, organ, or system that is manifested by a characteristic set of symptoms and signs and whose etiology, pathology, and prognosis may be known or unknown.
By this definition, it would seem no question that infertility is an interruption of the normal functioning of the reproduction system, and thus a disease. But for some, the issue is not so simple.
How Can Infertility Be a Disease When We Have Control over the Causes?
Infertility can be caused by many factors, including some within our control, such as delayed child bearing, smoking, weight (over and under), and sexually transmitted diseases. Also, some consider that the main symptom of infertility—the inability to have a biological child—is a desire, not a health condition.
The exact percentage of infertility caused exclusively by these “self-imposed factors” is hard to tease out. We know beyond a shadow of a doubt that infertility increases with a woman’s age. Even women with other abnormalities in their reproductive system are more likely to get pregnant if they try in their early 20s. The symptoms of many diseases, however, increase with age, so this factor alone should not preclude infertility from being considered a disease. Also, many diseases are caused or exacerbated by things we do. The vast majority of lung cancer is caused by smoking, but no one argues that lung cancer is not a disease.
Is Infertility a Social Issue or Medical Issue?
Whether not being able to reproduce is a medical or social condition is a more complex question, and certainly a more emotional one. Opponents to classifying infertility as a disease argue that wanting a child is not a medical issue. Since when, however, is someone else’s perception of the severity of the symptom a determinate in whether we classify something as a disease? By this reasoning, we could debate whether blindness is a “big enough issue” to warrant being a disease, since it is possible to live without sight, just as it is possible to live without a child.
How Money Factors Into Calling Infertility a Disease
As with so many things in life, money is at the unspoken heart of this debate. Insurance companies are more likely to cover treatment of infertility if it is classified as a disease.
“The debate comes down to this,” said Uwe E. Reinhardt, a health-care economist at Princeton University, “Is having your own offspring with your own genes a matter of human right? And if you can’t accomplish that on your own, do you have the right to have your efforts to achieve it financed?”
Coverage for infertility makes sense on so many levels, not the least of which is medical. For example, couples that are not able to afford the $13,000- 15,000 for in vitro fertilization might opt for the less expensive medicated intrauterine insemination (artificial insemination) procedure, which increases their odds of a multiple birth, especially the odds of higher order multiples such as triplets or quadruplets. Ironically, their health insurance will almost always cover the huge expenses for care of these preemies and their potential lifelong complications, and these cost dwarf the cost of IVF.
One of the most unusual arguments against classifying infertility as a disease and having insurance coverage for the treatment was made in a Newsweek magazine article. David Fleming, director of the Center for Health Ethics at the University of Missouri, said the main concern with making fertilization affordable for more people is the risk of “commoditization” of babies.
“The more you have access, the more people will do it,” says Fleming, arguing that the unfortunate part of making IVF more widespread is its increased ethical stakes, such as those surrounding more premature births, which ultimately increase the cost of health-care coverage for everyone, and more babies with congenital malformations, which are twice as common in babies conceived through IVF than naturally. “The concern is that we are placing these little humans in danger,” he says. “IVF, with all due respect—is it a question of need or a question of want?”
Humm, if I follow him correctly, he is saying that we shouldn’t pay for treatment of a disease because more people might seek treatment. Hello?!?
If the treatment is imperfect, how about spending more research dollars improving the treatment rather than looking for ways to keep more people from getting help. This brings me to one of my main arguments for classifying infertility as a disease. Government and private funding for basic research into the causes and treatment of infertility is far more likely if infertility is a disease.
Even though I count myself among those that argue for infertility being considered a disease deserving insurance and research dollars, I think we have to acknowledge the slippery slope we are on. Yes, we need insurance coverage, but we also need for IVF to be less expensive. Also, we need to freely admit that not all people who can’t conceive are suffering from a disease. The inability to reproduce is a natural part of the aging process, and in truth is not a disease. It seems to me that a 43 year old woman having trouble conceiving is suffering from aging, not infertility.
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Originally published in 2011; Updated in 2018. Image Credit: jobietan