It’s National Infertility Awareness Week. You might ask why it matters. The answer is based on a survey published in March 2021 that found that 40 percent of San Francisco residents are struggling with infertility.

Nationwide, according to the Centers for Disease Control, around 12 percent of women (and 9 percent of men) between the ages of 15 and 44 have difficulty getting pregnant or carrying a pregnancy to a live birth.

From ancient times to the Middle Ages, sterility was addressed with a cocktail of magic and religion. Hippocratic doctors boosted their infertility treatments – a mixture of medication, behavior modification, and the use of tubes – by turning to the deity Asclepius. In Egyptian lore, sterile women had their own sterile goddess Nephtys. In ancient Hindu texts, special mantras were recited and potions were prepared to increase the fertility of queens and royal women.

The stigma of sterility over the centuries and between cultures has turned its lens to the childless female body. Women were judged on their fertility. It was not until the Renaissance that infertility was recognized as a problem for both sexes.

More recently, in 2013, a study found that 30 percent of infertility cases were due to female factors, 20 percent to male factors, and 40 percent to problems in both partners. Reproductive endocrinologist and co-founder of CCRM Fertility in San Francisco, Dr. Salli Tazuke, confirmed these results in her own practice. Forty percent of their cases were due to complications in women, 35 to 40 percent in men, and many multi-factor couples.


The causes of infertility are many, including sexually transmitted diseases, environmental and workplace pressures, genetic and physical conditions, and, yes, infectious diseases. However, experts agree that not all causes are known.

One of the main reasons infertility spikes over the years is social and behavioral changes, according to Tazuke. The average couple looking to start a family these days are in their mid-thirties, she noted. “When people start late, the ovaries start to age,” and other health conditions like endometriosis and fibroids start to raise their heads. “We cannot fight aging,” said Tazuke, emphasizing that the amount and quality of eggs and sperm decreases as the human body ages.

The CDC has classified infertility as a health problem, although many could argue that infertility is not a disease. However, since data and scientific evidence have confirmed that health conditions cause infertility and infertility creates significant emotional challenges, there is no doubt that it is a health problem.

“The effects of infertility and its treatment can be devastating and include psychological stress, anxiety and depression,” said Adm. Robin M. Ikeda, CDC assistant director of non-communicable diseases, injuries and environmental health, at a conference in 2014.

In addition to increased anxiety and depression, one of the health risks is multiple births. The use of infertility treatments has resulted in twins, triplets, and more (remember Octomom?) Simultaneous births, which Ikeda says have “adverse outcomes for mother and child like premature birth,” according to Ikeda.

In addition, many of the causes of infertility are due to other health conditions, including obesity, diabetes, polycystic ovary syndrome (PCOS), and the development of fibroids or non-cancerous tumors that grow in the uterus.

One of the reasons it is important to view infertility as a medical diagnosis is because treatment options are equitable for all. Unfortunately, many health insurances in many states do not or only partially cover the costs of infertility treatment.

This can lead to high expenses, which inevitably leads to inequalities in access to treatment.

Infertility is more likely to affect BIPOC women. According to one study, black women have three times the risk of fibroids and probably fibroids than white women. Black women also have less access to infertility care and treatment than white women.

Tazuke said she sees fewer patients from color communities, and that’s mainly due to the cost of infertility treatments. Infertility treatment is not mandatory in California. On average, treatment costs without medication can range from $ 15,000 to $ 20,000. For medication, an additional $ 3,000 to $ 6,000 is the norm. Needless to say, this is a heavy price to pay with no guaranteed result.

According to Barbara Collura, President and CEO of RESOLVE, the National Infertility Association, insurers have often contested the cost of treatments that result in multiple births, but she adds, “But there is a confusing, illogical rationale for going out that looks because they are going to cover pregnancy, and they are going to cover these births, and so they are essentially going to cover the consequences of this lack of insurance. “

Experts agree that the goal is a healthy single birth. Modern science has come a long way, and the increased use of single embryo transfers is showing insurers that smart use of IVF can be very effective in reducing or eliminating those downstream costs of multiple births, argued Collura.

One way to avoid the high cost of infertility treatment is to gather information. “Access to infertility information is still lagging behind,” admitted Tazuke. However, it is important to be aware of options such as medications to improve ovaries, egg freezing, sperm banking, intrauterine insemination, and IVF.

When thinking about having a baby on the street, it may be wise to consider behaviors that will preserve fertility, reduce exposure to environmental hazards – pollutants in air, water, food, and health and beauty aids – and get regular checkups carry out reproductive health.

With infertility affecting two in five people in the city, most of us likely know someone who lives with infertility. This is the time to break the code of silence and shame and support our neighbors and friends who are struggling to raise families. Most importantly, it is time to ask our lawmakers to hire insurance coverage for the diagnosis and treatment of infertility.

Jaya Padmanabhan is a visiting columnist, and her point of view is not necessarily that of The Examiner. Twitter: @jayapadmanabhan.

Family health and medicine

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