Earlier intervention for infertility recommended

The definition of infertility has been revised to encourage earlier evaluation of women aged over 35 years who are having difficulty conceiving.

The new definition will be published in the June issue of Fertility and Sterility. The new definition was devised in part because insurers were adhering strictly to the existing guidelines, leading to a denial of access to appropriate treatment.

Infertility specialists say that the changes give credence to what’s been standard practice in their field. The real impact should come from the word getting out to other physicians.

This message is means for the generalist, not the reproductive endocrinologist.

According to the American Society for Reproductive Medicine will urge early evaluation and treatment of women who fail to achieve pregnancy after at least 12 months of regular unprotected intercourse. Evaluation will be warranted after six months for women aged over 35.

The ASRM also for the first time is specifically defining recurrent pregnancy loss as a disease distinct from infertility. It will be defined by two or more failed pregnancies documented by ultrasound or pathologic examination. When the cause is unknown, each pregnancy loss merits careful review to determine whether specific evaluations may be appropriate. After three or more losses, a thorough evaluation is warranted. The ASRM has thrown its weight behind what we in the field have done for awhile.

The clear statements on both infertility and recurrent pregnancy loss may also help convince insurance companies to cover evaluation and treatment — in instances where they haven’t in the past.

The statements could be helpful for reimbursement. For instance, insurers often consider recurrent pregnancy loss to be a form of infertility, which is inappropriate and untrue.

The statement of infertility will heighten patient and physician awareness that earlier evaluation is important. They said women are often told they have plenty of time to conceive.

The 6-month cut-off for women aged over 35 is somewhat arbitrary, but is necessary to prompt quicker action. Earlier evaluations may result in more findings of no abnormalities, but at least women will be reassured that they aren’t wasting time if they are told to spent another six months trying to conceive.

The ASRM statement could promote understanding. Women over age 35 should not be told to spend a year trying to conceive.