Infertility is typically described as one year of repeated intercourse without contraception that does not result in pregnancy. Numerous studies have shown that from sixty-five to ninety percent of all couples who conceive suddenly will do so within the first year of attempting and ninety to ninety-five percent will attain pregnancy within the first two years. However, fertility and infertility are not always absolutes. "Reduced fertility" would be a improved phrase than infertility in those situations where pregnancy is likely but takes longer than two years to achieve. About forty percent of "infertile" couples conceive in seven years, including those couples who are deemed treatment "failures". It is currently estimated that infertility affects at least five million couples, with at least one couple out of ten experiencing some difficulty in becoming pregnant. Although infertility rates have been constant for at least three decades, the impression of an infertility epidemic has been created because more and more women are postponing childbearing until they are well into their thirties. The 1990s have therefore witnessed a considerable increase in the number of couples seeking infertility evaluation. The desire for a biological child is so profound that couples may find themselves willingly impoverished by their efforts. From the very outset, a professional evaluation of infertility may add to the humiliation and sense of failure. The reproductive capacity of both partners will be examined and their sexual relations timed to comply with a doctor's suggestions. There is often an emotional toll when a man is told that his sperm count is below normal or a woman learns she does not produce enough of the necessary hormones. It may be particularly difficult for a woman to find herself infertile if she had a previous pregnancy voluntarily terminated because it was unplanned or inconvenient. By 1995 thousands and thousands of babies had been born nationwide through in vitro fertilization, following the famous first "test tube baby", Louise Brown, who was delivered in 1978. Through the use of new fertility drugs, tens of thousands more have been brought to term within the woman's body. The down side of these scientifically engineered miracles is that infertility treatment and care have become a big business, a two-billion-a-year business. In 1985 there were thirty fertility clinics in the United States and by 1995 there were more than three hundred. In order to recoup their investments and expand financially, those that are privately owned and operated (as compared with those connected to major medical centers) are being accused by some doctors of performing the riskier and more expensive procedures rather than those that are less complicated. It has also been pointed out that, as in other areas of medical practice, some physicians are choosing a procedure based on what the patient's insurance covers rather than the one that will be most cost effective. There have been many complaints from consumer advocates claiming that the infertility business has not been answerable to outside scrutiny about price, safety and positive accomplishments. These complaints resulted in the enactment of a federal law requiring all fertility clinics to disclose their pregnancy success rates in a way that will enable potential patients to make better comparisons; to establish uniform standards for clinics' laboratories; and, through an annual government report, to make public the names of those that do not meet them. |
