Report from the CDC
JOURNAL OF WOMEN’S HEALTH Volume 24, Number 7, 2015 ª Mary Ann Liebert, Inc. DOI: 10.1089/jwh.2015.5355
CDC Releases a National Public Health Action Plan for the Detection, Prevention, and Management of Infertility Lee Warner, PhD, MPH, Denise J. Jamieson, MD, MPH, and Wanda D. Barfield, MD, MPH
I
nfertility affects a significant percentage of reproductive-aged women and their partners in the United States, and the effects of not being able to have one’s own biologic children can be devastating.1 Nationally representative data from the Centers for Disease Control and Prevention’s (CDC’s) National Survey of Family Growth show that 6%, or an estimated 1.5 million U.S. couples, were infertile, meaning they were unable to conceive after 12 months of trying. Additionally, 12% of reproductive-aged women had impaired fecundity,2 meaning they had experienced difficulty conceiving or carrying a pregnancy to term during their lifetime. Although some perceive infertility as a qualityof-life issue, both the World Health Organization and the American Society for Reproductive Medicine3,4 define infertility as a disease of the reproductive system. Infertility has indications for health beyond the ability to have children. A diagnosis of infertility is a window of opportunity to improve care and detect unrecognized health conditions. Infertility may be caused by a range of factors of interest to public health, including genetic abnormalities, aging, acute and chronic diseases, treatments for certain conditions (e.g., autoimmune disorders, cancer); lifestyle and behavioral factors (e.g., sexually transmitted infections, smoking, obesity); and fetal or childhood exposures to environmental, occupational, and infectious agents.1,5 Many of these factors that impair fertility are well-known, preventable risks to overall health. According to the National Survey of Family Growth, 12% of women report that they or their partners have received infertility services in their lifetime.6 Racial/ethnic and geographic disparities, including differences in insurance coverage, can affect their access to diagnostic and treatment services. For example, compared with white women, African American women are more likely to experience tubal infertility,2 yet less likely to access care and treatment for infertility.6,7 Additionally, treatments for infertility, including ovulationinducing medications and assisted reproductive technology, can increase the risk of adverse health outcomes for women undergoing treatment and infants born from these procedures.8–10 In 2014, CDC, in partnership with governmental and nongovernmental organizations, professional societies, and organizations representing persons affected by infertility, released a national action plan11 to increase awareness and understanding of the public health implications of infertility. The
National Public Health Action Plan for the Detection, Prevention, and Management of Infertility is the first major publication to do so. The plan focuses on promoting healthy behaviors to help maintain and preserve fertility; promoting prevention, early detection, and treatment of medical conditions that threaten fertility; and reducing exposures to environmental, occupational, infectious, and iatrogenic agents that affect fertility. Because of its public health focus, the plan also calls for strategies to promote healthy pregnancy outcomes associated with treating and managing infertility and to improve the safety and efficacy of infertility treatments. To learn more about the National Public Health Action Plan for the Detection, Prevention, and Management of Infertility and download the report, readers can visit CDC’s website at www.cdc.gov/reproductivehealth/Infertility/PublicHealth .htm. Requests for hard copies of the report can be sent to [email protected]. Readers are also invited to view an August 2014 CDC Public Health Grand Rounds, ‘‘Time for Public Health Action on Infertility,’’ which highlights the plan, at www.cdc.gov/cdcgrandrounds/archives/2014/august2014.htm. To learn more about other CDC activities regarding infertility, visit www.cdc.gov/reproductivehealth/Infertility/index.htm. Acknowledgments
The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Author Disclosure Statement
No competing financial interests exist. References
1. Macaluso M, Wright-Schnapp TJ, Chandra A, et al. A public health focus on infertility prevention, detection, and management. Fertil Steril 2010;93:16.e1–e10. 2. Chandra A, Copen CE, Stephen EH. Infertility and impaired fecundity in the United States, 1982–2010: Data from the National Survey of Family Growth. National Health Statistics Reports 67. Hyattsville, MD: National Center for Health Statistics, 2013.
Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
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NATIONAL ACTION PLAN FOR INFERTILITY
3. Practice Committee of the American Society for Reproductive Medicine. Definitions of infertility and recurrent pregnancy loss: A committee opinion. Fertil Steril 2013;99:63. 4. Zegers-Hochschild F, Adamson GD, de Mouzon J, et al. International Committee for Monitoring Assisted Reproductive Technology; World Health Organization. International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) revised glossary of ART terminology, 2009. Fertil Steril 2009;92:1520–1524. 5. Homan GF, Davies M, Norman R. The impact of lifestyle factors on reproductive performance in the general population and those undergoing infertility treatment: A review. Hum Reprod Update 2007;13:209–223. 6. Chandra A, Copen CE, Stephen EH. Infertility service use in the United States: Data from the National Survey of Family Growth, 1982–2010. National Health Statistics Reports 73. Hyattsville, MD: National Center for Health Statistics, 2014. 7. Jain T. Socioeconomic and racial disparities among infertility patients seeking care. Fertil Steril 2006:85:876–881. 8. Hansen M, Bower C, Milne E, de Klerk N, Kurinczuk JJ. Assisted reproductive technologies and the risk of birth defects—A systematic review. Hum Reprod 2005;20:328– 338.
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9. Schieve LA, Devine O, Boyle CA, Petrini JR, Warner L. Estimation of the contribution of non-assisted reproductive technology ovulation stimulation fertility treatments to US singleton and multiple births. Am J Epidemiol 2009;170: 1396–1407. 10. Kulkarni AD, Jamieson DJ, Jones HW Jr, et al. Fertility treatments and multiple births in the United States. N Engl J Med 2013;369:2218–2225. 11. Centers for Disease Control and Prevention. National public health action plan for the detection, prevention, and management of infertility. Atlanta, GA: Centers for Disease Control and Prevention, 2014.
Address correspondence to: Lee Warner, PhD, MPH Division of Reproductive Health National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention 4770 Buford Highway Northeast, Mailstop F-74 Atlanta, GA 30341 E-mail: [email protected]
JOURNAL OF WOMEN’S HEALTH Volume 24, Number 7, 2015 ª Mary Ann Liebert, Inc. DOI: 10.1089/jwh.2015.5355
CDC Releases a National Public Health Action Plan for the Detection, Prevention, and Management of Infertility Lee Warner, PhD, MPH, Denise J. Jamieson, MD, MPH, and Wanda D. Barfield, MD, MPH
I
nfertility affects a significant percentage of reproductive-aged women and their partners in the United States, and the effects of not being able to have one’s own biologic children can be devastating.1 Nationally representative data from the Centers for Disease Control and Prevention’s (CDC’s) National Survey of Family Growth show that 6%, or an estimated 1.5 million U.S. couples, were infertile, meaning they were unable to conceive after 12 months of trying. Additionally, 12% of reproductive-aged women had impaired fecundity,2 meaning they had experienced difficulty conceiving or carrying a pregnancy to term during their lifetime. Although some perceive infertility as a qualityof-life issue, both the World Health Organization and the American Society for Reproductive Medicine3,4 define infertility as a disease of the reproductive system. Infertility has indications for health beyond the ability to have children. A diagnosis of infertility is a window of opportunity to improve care and detect unrecognized health conditions. Infertility may be caused by a range of factors of interest to public health, including genetic abnormalities, aging, acute and chronic diseases, treatments for certain conditions (e.g., autoimmune disorders, cancer); lifestyle and behavioral factors (e.g., sexually transmitted infections, smoking, obesity); and fetal or childhood exposures to environmental, occupational, and infectious agents.1,5 Many of these factors that impair fertility are well-known, preventable risks to overall health. According to the National Survey of Family Growth, 12% of women report that they or their partners have received infertility services in their lifetime.6 Racial/ethnic and geographic disparities, including differences in insurance coverage, can affect their access to diagnostic and treatment services. For example, compared with white women, African American women are more likely to experience tubal infertility,2 yet less likely to access care and treatment for infertility.6,7 Additionally, treatments for infertility, including ovulationinducing medications and assisted reproductive technology, can increase the risk of adverse health outcomes for women undergoing treatment and infants born from these procedures.8–10 In 2014, CDC, in partnership with governmental and nongovernmental organizations, professional societies, and organizations representing persons affected by infertility, released a national action plan11 to increase awareness and understanding of the public health implications of infertility. The
National Public Health Action Plan for the Detection, Prevention, and Management of Infertility is the first major publication to do so. The plan focuses on promoting healthy behaviors to help maintain and preserve fertility; promoting prevention, early detection, and treatment of medical conditions that threaten fertility; and reducing exposures to environmental, occupational, infectious, and iatrogenic agents that affect fertility. Because of its public health focus, the plan also calls for strategies to promote healthy pregnancy outcomes associated with treating and managing infertility and to improve the safety and efficacy of infertility treatments. To learn more about the National Public Health Action Plan for the Detection, Prevention, and Management of Infertility and download the report, readers can visit CDC’s website at www.cdc.gov/reproductivehealth/Infertility/PublicHealth .htm. Requests for hard copies of the report can be sent to [email protected]. Readers are also invited to view an August 2014 CDC Public Health Grand Rounds, ‘‘Time for Public Health Action on Infertility,’’ which highlights the plan, at www.cdc.gov/cdcgrandrounds/archives/2014/august2014.htm. To learn more about other CDC activities regarding infertility, visit www.cdc.gov/reproductivehealth/Infertility/index.htm. Acknowledgments
The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Author Disclosure Statement
No competing financial interests exist. References
1. Macaluso M, Wright-Schnapp TJ, Chandra A, et al. A public health focus on infertility prevention, detection, and management. Fertil Steril 2010;93:16.e1–e10. 2. Chandra A, Copen CE, Stephen EH. Infertility and impaired fecundity in the United States, 1982–2010: Data from the National Survey of Family Growth. National Health Statistics Reports 67. Hyattsville, MD: National Center for Health Statistics, 2013.
Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
548
NATIONAL ACTION PLAN FOR INFERTILITY
3. Practice Committee of the American Society for Reproductive Medicine. Definitions of infertility and recurrent pregnancy loss: A committee opinion. Fertil Steril 2013;99:63. 4. Zegers-Hochschild F, Adamson GD, de Mouzon J, et al. International Committee for Monitoring Assisted Reproductive Technology; World Health Organization. International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) revised glossary of ART terminology, 2009. Fertil Steril 2009;92:1520–1524. 5. Homan GF, Davies M, Norman R. The impact of lifestyle factors on reproductive performance in the general population and those undergoing infertility treatment: A review. Hum Reprod Update 2007;13:209–223. 6. Chandra A, Copen CE, Stephen EH. Infertility service use in the United States: Data from the National Survey of Family Growth, 1982–2010. National Health Statistics Reports 73. Hyattsville, MD: National Center for Health Statistics, 2014. 7. Jain T. Socioeconomic and racial disparities among infertility patients seeking care. Fertil Steril 2006:85:876–881. 8. Hansen M, Bower C, Milne E, de Klerk N, Kurinczuk JJ. Assisted reproductive technologies and the risk of birth defects—A systematic review. Hum Reprod 2005;20:328– 338.
549
9. Schieve LA, Devine O, Boyle CA, Petrini JR, Warner L. Estimation of the contribution of non-assisted reproductive technology ovulation stimulation fertility treatments to US singleton and multiple births. Am J Epidemiol 2009;170: 1396–1407. 10. Kulkarni AD, Jamieson DJ, Jones HW Jr, et al. Fertility treatments and multiple births in the United States. N Engl J Med 2013;369:2218–2225. 11. Centers for Disease Control and Prevention. National public health action plan for the detection, prevention, and management of infertility. Atlanta, GA: Centers for Disease Control and Prevention, 2014.
Address correspondence to: Lee Warner, PhD, MPH Division of Reproductive Health National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention 4770 Buford Highway Northeast, Mailstop F-74 Atlanta, GA 30341 E-mail: [email protected]
