Infertility impact
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]
Impact
Ethical Impact
There are several ethical issues associated with infertility and its treatment.
- High-cost treatments are out of financial reach for some couples.
- Debate over whether health insurance companies should be forced to cover infertility treatment.
- Allocation of medical resources that could be used elsewhere
- The legal status of embryos fertilized in vitro and not transferred in vivo.
- Anti-abortion opposition to the destruction of embryos not transferred in vivo.
- IVF and other fertility treatments have resulted in an increase in multiple births, provoking ethical analysis because of the link between multiple pregnancies,premature birth, and a host of health problems.
- Religious leaders' opinions on fertility treatments.
- Infertility caused by DNA defects on the Y chromosome is passed on from father to son. If natural selection is the primary error correction mechanism that prevents random mutations on the Y chromosome, then fertility treatments for men with abnormal sperm (in particular ICSI) only defer the underlying problem to the next male generation.
Psychological Impact
Infertility may have profound psychological effects. Partners may become more anxious to conceive, ironically increasing sexual dysfunction. Marital discord often develops in infertile couples, especially when they are under pressure to make medical decisions. Women trying to conceive often have clinical depression rates similar to women who have heart disease or cancer[1]. Even couples undertaking IVF face considerable stress, especially the female partner [2]
Social Impact
In many cultures, inability to conceive bears a stigma. In closed social groups, a degree of rejection (or a sense of being rejected by the couple) may cause considerable anxiety and disappointment. Some respond by actively avoiding the issue altogether; middle-class men are the most likely to respond in this way.
There are legal ramifications as well. Infertility has begun to gain more exposure to legal domains. An estimated 4 million workers in the U.S. used the Family and Medical Leave Act (FMLA) in 2004 to care for a child, parent or spouse, or because of their own personal illness. Many treatments for infertility, including diagnostic tests, surgery and therapy for depression, can qualify one for FMLA leave.
References
- ↑ Domar AD, Zuttermeister PC, Friedman R. The psychological impact of infertility: a comparison with patients with other medical conditions.J Psychosom Obstet Gynaecol. 1993;14 Suppl:45-52. PMID 8142988.
- ↑ Beutel M, Kupfer J, Kirchmeyer P, Kehde S, Kohn FM, Schroeder-Printzen I, Gips H, Herrero HJG, Weidner W. Treatment-related stresses and depression in couples undergoing assisted reproductive treatment by IVF or ICSI. Andrologia. 31 (1999): 27-35.