Infertility is a global public health issue
"The different needs in reproductive health are simultaneous and consecutive related needs. People cannot be healthy if they have one element of the Reproductive Health package but miss others." Mahmoud Fathalla, Former Director of HRP*.
Infertility and subfertility affect a significant proportion of humanity. WHO has calculated that over 10% of women are inflicted – women who have tried unsuccessfully, and have remained in a stable relationship for five years or more. Estimates in women using a two year time frame, result in prevalence values 2.5 times larger. The burden in men is unknown. The overall burden of subfertility/infertility is significant, likely underestimated, and has not displayed any decrease over the last 20 years.
Infertility is defined as a “disease of the reproductive system” and results in disability. Despite the high burden, couples and individuals, who desire but are unable to achieve and maintain a desired pregnancy, have needs which are not being addressed, especially in lower resource settings worldwide. Yet, the field of reproductive medicine and endocrinology is rapidly growing, with success stories that have resolved infertility and fertility problems – from the most simple fertility awareness methods to more advanced innovations.
The innovation of human in vitro fertilization (IVF) was developed by Robert Edwards, who was recently honoured with the Nobel Prize (see side bar). Therapies and treatments associated with IVF can also be utilized to avoid hereditary disease in offspring, to address male factors, to decrease STI/HIV transmission, to address the trend in desired older-aged parenthood, or to aid those who face cancer therapies that jeopardize their reproductive potential.
Current and future research in the area of subfertility/infertility will not only serve itself, however may:
- assist in finding innovations for new methods of contraception;
- help to resolve issues of recurrent spontaneous miscarriage;
- help to address complications associated with pre-term birth or other neonatal complications; and,
- be exploited to ensure zero (horizontal and vertical) transmission of sexually transmitted diseases and HIV.
Implementation research is required within developing countries where the global burden of infertility is greatest, ensuring:
- greater emphasis on innovative, safe and cost-effective solutions; and,
- improved implementation and integration of access to subfertility/infertility diagnosis, management and treatment.
If the gap of “Reproduction” is no longer lost within the reproductive life cycle, this will help to ensure success for the UN Secretary-General’s Global Strategy for Women and Children's Health, the Countdown to ZERO initiative for HIV and AIDS, to assist other reproductive health care initiatives, and help to ensure provision of continuum-of-care in sexual and reproductive health.
* UNDP/UNICEF/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction has been widely known for many years by the abbreviation (HRP).