Public Health

AMA backs global health experts in calling infertility a disease

Sara Berg, MS , News Editor

More than one in eight couples of childbearing age have difficulty conceiving or carrying a pregnancy to term, according to the Centers for Disease Control and Prevention. Experts at the World Health Organization (WHO) and the American Society for Reproductive Medicine (ASRM) have designated infertility a disease.

Delegates at the 2017 AMA Annual Meeting voted in support of WHO’s designation of infertility as a disease.  The declaration could have a broader impact on how patients, insurers and society conceive of and act with regard to infertility.

Causes of infertility are present in both men and women, with about 40 percent of all infertile couples demonstrating a combination of factors. And in about 15 percent of couples, no physiological dysfunction can be identified, making a definite diagnosis difficult. Infertility in both men and women leads to a decline in many quality-of-life metrics, including depression, shame, guilt, inadequacy and social isolation. Early treatment of infertility improves these metrics and the overall prospects of pregnancy, according to data provided in the resolution adopted by the AMA House of Delegates (HOD).

Infertility affects 15 percent of couples and is recognized as a complex disease by WHO and ASRM. Some of the largest health insurance companies in the U.S., including Cigna, Optum Health and Aetna, cover some treatments. However, not all insurance companies cover treatment.

Delegates offered unanimous reference-committee testimony supportive of designating infertility as a disease state with an emphasis on how this would promote insurance coverage and payment. Many cited experience in treating couples with infertility and noted complicated testing and treatments as well as the stigma associated with the situation.

The HOD adopted policy supporting WHO’s designation of infertility as a disease state with multiple etiologies requiring a range of interventions to advance fertility treatment and prevention.

Those patients who do conceive, by any method, now have new advice from the AMA on proper prenatal vitamin supplementation.

Adequate levels of choline—an important nutrient that helps a baby’s brain and spinal cord to develop properly—are necessary to maintain normal pregnancy including neural development of the fetus and reducing the incidence of birth defects.

Inadequate choline levels during pregnancy are thought to negatively affect cognitive development. Neural tube and hippocampus development also are dependent on adequate choline intake.

Prenatal vitamins only contain 0–55 mg of choline, leaving the majority of pregnant and lactating women without enough dietary choline to protect the health and development of their babies, according to data cited in a resolution adopted by the HOD.

Delegates voted to support evidence-based amounts of choline in all prenatal vitamins.

Read more news coverage from the 2017 AMA Annual Meeting.