OTA finds infertility a $1 bilion problem.

OTA Finds infertility a $1 billion problem

Ten years after the birth of the world's first "test tube baby," helping infertile couples make babies has become big business, says an Office of Technology Assessment (OTA) report released this week. In the United States, infertile couples spent about $1 billion last year on medical treatments aimed at conception. But half may remain childless, says the report, which calls for greater emphasis on prevention of infertility and better evaluation of the latest reproduction technologies. The report also criticizes the Department of Health and Human Services (HHS) for what OTA calls a failure to address some of the more emotional issues involved, including funding for research on fertilization in the laboratory.

An estimated 2.4 million U.S. couples suffer from infertility -- the inability to conceive after one year of intercourse without contraception. Not all seek treatment, and more than half already have at least one biological child. But fertility problems will place an increasingly heavy burden on U.S. health care, according to the new report. Between 1965 and 1982, the number of infertility-related visits to a physician rose from 600,000 each year to 1.6 million, although the overall number of infertile couples remained about the same. As a result of these visits, as many as 200,000 babies -- or 5 percent of the total -- are born each year. Most of these "assisted reproductions" result from now-standard procedures, such as surgery to open blocked tubes and artificial insemination.

At technology's leading edge, however, are such emotion-laden issues as surrogate motherhood and in vitro fertilization (IVF). In the future, predicts the OTA report, roughly 100 "surrogate mother arrangements" will be made each year, despite present confusion over these contracts' legality. Although half of the 169 IVF programs in the United States have poor records and only 1 in 10 IVF patients becomes pregnant during treatment, the report predicts improving success rates. Costing $4,000 to $6,000 per treatment, IVF would still exclude the poor.

Government inaction has stymied IVF research, says Gary B. Ellis, the OTA project leader. Federal regulations mandate that, in order to receive public funding, proposals on human IVF research must by reviewed by an HHS ethics advisory board. In a 1979 report, such a group found this research ethically acceptable and concluded that "a broad prohibition of research involving human IVF is neither justified nor wise." The next year, however, HHS officials allowed the board to expire, essentially creating a moratorium on human IVF research that still exists. Ellis, who calls the situation "a blockade of research," said in an interview his agency regards HHS as "living in violation of its own regulations."

Among the options for Congress, the report lists the appointment of a new board and the expansion of federal support for both IVF research and male infertility. The report also notes that eight other countries, including Great Britain and Australia, have directly addressed the ethical and legislative issues involved in reproduction technologies, whereas the United States has not.

Ellis says OTA officials consider the prevention of infertility one of the more important issues to be addressed, because so many cases are "eminently preventable." The study found about 20 percent of infertility cases are due to treatable causes such as sexually transmitted diseases. Ellis, who stresses that OTA's function is merely to "lay out options," says the government could classify common, infertility-causing chlamydial infection as a so-called reportable disease, making it easier to track.