Written by Fr.Richard Nazzareno Farrugia

How to tackle infertility

The rate of infertile couples is on the rise both in developed and developing countries. It is a cause of great suffering for those involved and their legitimate desire to have a child requires the attention of society.

Infertility needs to be addressed seriously. This seems to be one of the motivations behind the workshop themed The Management Of Infertility Today, organised by the Pontifical Academy for Life on February 24 as part of the 18th general assembly of the homonymous entity inviting experts from all over the globe, including Gamal Serour, president of the International Federation of Gynaecology and Obstetrics (FIGO).

From the lectures delivered it was possible to have an up-to-date analysis of the situation with the illustration of the results of the latest research done as regards the phenomenon of infertility, its diagnosis and treatment. It clearly emerges that infertility is caused by multiple factors and, consequently, necessitates a broader response than just that pertaining to research in artificial reproductive treatment.

According to Hans Rudolf Tinneberg, of Justus-Liebig University in Giessen, Germany, the true challenge is that of changing the mental attitude of people so that they procreate when it is biologically the optimal age to do that, between 21 and 23 years old! Said in this way, it may seem as an unacceptable statement but here is an expert speaking from a scientific perspective on what the most effective solution would be! Surely, this statement should not be taken out of context.

During the workshop it clearly emerged that modern lifestyle patterns also play an important role in the problem of infertility. However, it was pointed out that lifestyles depend on social and economic structures that lead people to marry and decide to have children at an older age.

For Dr Serour, the answer lies in proposing a good health education that helps young people to not forget their biological potential and regard reproduction as “production” in the sense that it’s not an impediment to one’s fulfilment.

However, if in our societies there isn’t a policy and an economic system that is family-friendly, health education alone will not reach this goal. That’s why the president of FIGO added that, in order to address the problem of infertility, the role of politicians is fundamental for the implementation of a successful policy.

Various other factors were mentioned. A factor that recurred was the negative impact of environmental pollution on fertility and the harmful consequences of active and passive smoking to female and male infertility.

Eating disorders, anorexia or obesity are equally worrying as is excessive body exercise. Moreover, most lecturers underlined that psychological stress is a frequently recurring factor among infertile patients.

For gynaecologists and andrologists, says Daria Minucci of Padua University, accompanying infertile couples is more than just a question of curing: it is a call for care. The latter involves the coming together of various people to help the infertile couple, including the psychologist and, in the case of believers, the spiritual counsellor. In such a way, Charles Chapron, of the Cochin University Hospital in Paris, notes the problem of infertility is allocated its correct place, that is in an interdisciplinary context because it’s not just a medical issue.

The outcome of these scientific proceedings, to be published in the near future in the FIGO journal, should be of particular relevance for us Maltese because, in the coming weeks, the first reading of the Bill on in vitro fertilisation will take place.

It would be erroneous and myopic to regard these proceedings as irrelevant just because they were organised by a Pontifical institute. The experts invited by the Academy for Life came from different beliefs and also, in certain aspects, differed in their conclusions.

What I would like to stress is that it was not a kind of “Catholic reunion” of Catholics talking to Catholics. It was a scientific workshop presented by competent experts.

For example, some of the experts, such as Dr Tinneberg and Eberhard Nieschlag, of the Universitätsklinikum in Münster, Germany, affirmed their personal position in favour of IVF and intracytoplasmic sperm injection (ICSI). In doing so, they faced the contestation of other experts, among them Thomas W. Hilgers, of the Institute Pope Paul VI for the Study of Human Reproduction, situated in Omaha, USA.

However, all experts concurred on the fact that IVF is not the only solution and could not be presented as such when infertile couples call upon gynaecologists and andrologists for help.

Moreover, it is evident from empirical research that IVF does not address the causes of infertility and it is statistically proven that, since its outcome, it didn’t solve the problem of infertility. The problem is still there.

Referring to studies conducted in the US, Dr Hilgers stated that 99.5 per cent of those who in the US have infertility problems are not served by IVF. In addition, he said that, in the clinics where the infertile couples seek help, often IVF is presented as the sole solution without a previous thorough diagnostic investigation. In fact, a number of patients coming to the NaPro Technology centres after the failed attempts of IVF had endometriosis, a gynaecological medical condition that could be treated, but that was not diagnosed in the centres that do IVF, leaving the patients unaware about the true cause of their infertility.

As Parliament is to discuss the Bill on IVF, it is fitting to ask what are the principles that will be defended and also whether it takes into consideration all scientific evidence available to date.

The Bill cannot be presented as a real solution or an adequate response to the problem of infertile couples. The state cannot be satisfied just because it will regulate IVF as though that will be the definite answer to the whole issue.

It would be more problematic and questionable if a future IVF-law would allocate state funds to favour this method in the face of studies that would make it more logical to fund research that would directly address the problems of infertility and make progress to tackle its roots.

It is also opportune to ask whether infertile couples in Malta would be correctly diagnosed, keeping in mind the multi factors of infertility, and eventually have access, if it is the case, to easier and cheaper treatments other than IVF.

Equally important is to ask whether parliamentarians will consider how to address the other factors mentioned above if there is an honest intention to help out infertile couples and respond to the problem of infertility.

Infertility is a serious problem and needs to be tackled accordingly.