Prevention of Infertility

The number of infertile men and women are increasing every day. There is a growing volume of proof that sociological and medical factors are resulting in an increasing number of infertile people in this country. The trend toward delaying marriage and childbearing into the years after thirty is one factor. Another is venereal disease, which is rampant in all social strata. Adolescents, who are most prone to VD, are having sexual relations earlier and more frequently than past generations, adding to their risk of repeated infections.

Some forms of birth control are now under scrutiny. Fertility clinics are seeing an increasing number of women who have ceased ovulating after use of the Pill. The intrauterine device (IUD) has also been implicated in infertility. It is suspected that a 1 to 5 percent infection rate accompanies insertion of an IUD. With over 4 million Americans now using IUDs, these numbers become statistically significant. The leading serious side effect of the IUD is pelvic inflammatory disease (PID), or infection of the uterus, the tubes, and even the peritoneal cavity. Coincidentally, one leading cause of infertility in women is PID.

Therapeutic abortion has been legal since the Supreme Court decision of January 22, 1973. One of the hopes of its advocates was that women would no longer be subjected to the risks and trauma of "black market" abortionists. Evidence is now coming to light that abortion, even under the most ideal circumstances, is accompanied by a risk of infection, at a rate conservatively estimated to be from 1 to 5 percent. In addition, it is known that hasty or vigorous dilation of the cervix, expecially in the very young woman, may cause permanent damage to the cervix. Subsequent desired pregnancies may be lost by a cervix rendered incompetent.

So how do we help prevent infertility? The average American adolescent still gets relatively little preparation for his or her developing sexuality. In some school systems, and in some homes and churches, careful and thoughtful time is given to the issues of one's bodily changes and the accompanying emotional changes, reproduction, contraception, hygiene, and sexual roles in life. A totally neglected area in most curricula is infertility as one possible circumstance. It is most often mentioned as a scare tactic in the unit on venereal disease. Information about infertility should be included in any comprehensive sexual education program, especially because some important preventive measures should be taught early to adolescents. Here are some precautions that may help ensure fertility (or lessen destruction of natural fertility):

1. Any infection of the reproductive tract in either male or female, regardless of the means of infection and the particular organism involved, should be treated immediately by a doctor. Some symptoms to be alert for: discharge from the vagina or penis; pain on urination; low-grade fever; chancre (open sores) of the genitals; pelvic tenderness or pain in women; rashes. Because gonorrhea is asymptomatic in 75 percent of women, those who are sexually active with multiple partners should have a culture done every six months.

2. All prepubescent boys should be immunized against mumps. When mumps occurs in the postpubescent male, it may be accompanied by orchitis (inflammation of the testis), which may lead to subsequent infertility.

3. Any woman who has not already established normal, regular menses or who is experiencing irregular menstrual cycles (or very scanty or very heavy menstruation) is probably not a good candidate for birth-control pills. Taking the Pill for more than two years is not recommended.

4. The choice to use an IUD should be made very carefully. It should not be inserted when any infection of the reproductive tract is present and should generally be removed if a subsequent infection develops.

5. The decision to have an abortion should be made very carefully. Cervical dilation by means of a "laminaria" wick inserted the day before is often advisable when the cervix is very tight and firm. Any post-abortion symptoms of infection — fever , foul discharge, heavy bleeding, pelvic tenderness — should be promptly reported to the doctor and treated.