Infertility

Is infertility a disease or a condition or a symptom?

Is infertility a disease or a condition or a symptom? This aspect is much debated and very diverse opinions exist on this topic. But let us first review some formal considerations: The World Health Organization defines infertility to be “a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse”. There are furthermore a multitude of definitions varying from clinical, demographic, epidemiological and even as a disability. Then there are definitions for infertility relating to the male or female only. This represents one of the mine fields. Who is diseased in the end? The male, the female or the couple?

But why is there such a huge debate and does it matter if infertility is classified as a disease or not? Most of the debate apparently and mainly has to do with three major aspects: It seems that governments are unlikely to fund infertility if it is not considered a disease; secondly, many researchers in the field argue that they will struggle to get funding even from the pharmaceutical industry if infertility is not considered a disease; there are also many ethical and philosophical aspects to be considered.

Dr Hane Maung, of Lancaster University, asks whether government funding for fertility treatment should be framed as fighting disease?  Dr Maung argues in this context that “…there are many causes of infertility. There may be anatomical or physiological anomalies; fertility declines with advancing age; some can conceive with one partner but not with another; those who are in same-sex relationships or childless by choice are socially infertile. It is possible that some cases of infertility could be considered diseases while other causes could not”.

A survey by the BMJ (2002), indicated that infertility appeared on the list of ‘non-diseases’ as a ‘variant of normal’ and only 38% of participants agreed that infertility is a disease (Human Reproduction, 2000).

Dickey and colleagues in a response to an Editorial in a Reproductive Biology journal clearly state:  “A major obstacle to the treatment of infertility as a symptom by the Health Insurance Industry is the way it is characterized in the International Classification of Diseases, Volume 9 (ICD). In the ICD, female infertility (Code 628.0) and male infertility (606.0) are classified as diseases but are clearly treated as symptoms”! Does it make sense? No.

Ethical issues have become more prominent in the overall debate. Couples that cannot conceive are distressed and arguments about the status of fertility as disease or not does not alleviate their problem of childlessness. It is clear that more attention need to be devoted to these ethical and philosophical aspects in the context that infertility is a symptom and not a disease.

Dickey and colleagues from Louisiana State University finally make this very important point: “The facts are that infertility”….., is not a disease; “they are symptoms of underlying, sometimes serious disease in one or both marital partners. One result of considering infertility and anovulation as diseases rather than as symptoms is that unnecessarily powerful and expensive treatments may be used to obtain an immediate pregnancy, whereas chronic disease that may affect lifelong health is overlooked”.

We need to consider: Chronic back pain and chronic chest pain may simply be symptoms of serious underlying disease and as Dickey and colleagues pointed out: infertility may be caused by underlying disease too.

It seems infertility is not a disease but is complex and involve multiple factors from genetic… to… behaviour.

Prof Gerhard van der Horst (PhD, PhD)
Senior Consultant
MICROPTIC S.L.