A common misperception is that infertility is becoming more common. In fact, the infertility rate has held relatively stable over the years. Instead, two major factors account for the increased utilization of fertility services.
The first of these factors is simply the greater availability of the services themselves. Prior to the 1978 birth of Louise Brown, the world’s first baby conceived through in vitro fertilization (IVF), the options available to treat an infertile couple were limited to tubal microsurgery and ovulation induction with medications such as clomiphene citrate (Clomid). With the development of advanced reproductive technologies (ART), the techniques used to treat infertile couples have become both much more successful and more accessible. Fertility providers now practice throughout nearly all urban centers in the continental United States, with more than 400 IVF clinics reporting their success rates through the Society for Assisted Reproductive Technologies (SART) and the Centers for Disease Control and Prevention (CDC). Statistics from all reporting IVF clinics are available at http://www.cdc.gov/ART/index.htm.
The second factor accounting for the increased use of fertility services is the trend toward delayed childbearing. Over the last generation, a significant number of women have deferred childbearing while they pursued advanced academic careers or entered the workplace. Unfortunately, female reproductive capacity drops from a peak in the second and third decades of life so that, by the age of 40 years, there is a marked reduction in fertility and an increased risk of miscarriage.
Finally, the stigma associated with fertility treatments themselves has also eased in recent years, prompting more couples to seek out such help. Previously, couples who were seeking fertility treatments often found themselves beset by a bewildering array of options and knew few other couples with whom they could discuss the range of treatments. Today, more than 100,000 cycles of ART are performed in the United States every year. Given that 1% of all U.S. births are now the result of fertility treatments, most couples probably know someone with a successful outcome from fertility treatments.
The current explosion of information available through the Internet and through organizations such as the American Society for Reproductive Medicine (ASRM), RESOLVE, and the American Fertility Association has allowed patients to better understand fertility related problems and seek appropriate care. A number of states have implemented mandates that guarantee varying levels of insurance coverage for fertility-related procedures, which has had the effect of easing the financial burden for couples who seek out this type of care.
When I started discussing my fertility problems with my mother, she opened up about her own struggles to conceive my brother and me. While she did eventually get pregnant on her own, it took her over 2 years to conceive me and about the same amount of time to conceive my brother. She said that nobody really talked about infertility when she was trying to get pregnant and the fertility options were minimal. My mother was an only child because my grandmother could never become pregnant again despite years of trying. I would guess that both my grandmother and my mother had the same infertility diagnosis as I do—PCOS [polycystic ovarian syndrome]—but in their childbearing years it was not commonly diagnosed and treatments were either nonexistent or limited.