Infertility, Incidence of

Definition and Diagnosis

The medical industry generally diagnoses infertility for a heterosexual couple if neither spouse is surgically sterile, they had correctly timed sexual intercourse, had not used contraception, and had not become pregnant during the past 12 months or longer, although some physicians, especially specialists, will even treat couples after six months of trying to become pregnant. Some believe that the availability of for-profit fertility treatments has created an unrealistic time frame. The World Health Organization defines infertility if there is no conception after two years of unprotected sexual intercourse with the same partner. This definition is supported by a 2004 finding by the National Collaborating Centre for Women's and Children's Health that states that under normal conditions, about 84 percent of couples in the general population will conceive within one year if they do not use contraception. Of those who do not conceive in the first year, half will do so in the second year. Moreover, 94 percent of women over 35 and 77 percent of women over 38 will conceive after three years of trying.

Whereas physicians often dismiss women's self-diagnoses from charting, how to diagnose infertility is not agreed upon by the medical community. One general indicator is age, where women over 35 years old are treated more aggressively even though women under 35 are the largest consumers of fertility treatments, which some call a “prognosis-oriented approach,” where women are recommended to proceed to treatments following an often incomplete diagnostic workup.

Beyond age, symptoms of infertility are debated in the medical field, which leads to a lack of standardization in diagnostic tests. Despite a basic diagnostic workup outlined by the American Fertility Society and the World Health Organization, a lack of agreement exists among fertility specialists with regard to how to interpret diagnostic tests, which tests to perform, what their prognostic utility is, and what should be judged as “normal.” Findings suggest that variability exists in which tests are performed based on the type of practice and physician age and gender.

Rates

Fifty years ago, infertility was a “non-issue” as the topic was not discussed socially and little was known about it scientifically. Now, however, there are countless media reports, more infertile women in the population, and a larger proportion of infertile couples seeking treatment in a fertility industry that is estimated at $3 billion annually. In the United States, rates of involuntary childlessness are reported to be increasing; 2002 reports from the Centers for Disease Control and Prevention show that 7.4 percent of married women experienced infertility. By 2007, it was reported that 1 in 7 men and women experienced infertility. Infertility also affects on average 8-12 percent of couples worldwide. Rates vary from country to country; in the worst-affected areas, over 25 percent of couples may be unable to conceive. These numbers, however, may not represent the entire world because infertility problems are underreported in developing countries due to the focus on perceived overpopulation problems.

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