Chapter 38: Trends and Deficiencies in Infertility

Hilgers TW

Infertility · Evaluation

Chapter 38: Trends and Deficiencies in Infertility

Hilgers TW

The Medical and Surgical Practice of NaProTECHNOLOGY, 477-494, 2004

RRM Academy Synopsis

Most infertility patients get no adequate diagnosis, a chapter argues

A 2004 textbook chapter argues that modern fertility care leaves most patients without an adequate diagnosis. The author critiques the 2001 CDC national ART summary. The summary counted 29,344 live births. Only 21.7 percent of women began a second cycle.

Key Findings

In 2001, US ART programs produced 29,344 live births, resulting in 40,687 babies.
The chapter puts the share of the 6,200,000 US women with impaired fecundity who were helped by ART at 0.47 percent.
The national summary reports pregnancy rates for each cycle started, with no per woman rate. Only 21.7 percent of women entered a second cycle.
Of 21,813 live births from fresh non-donor cycles, 35.8 percent were multiple births: 32.0 percent twins and 3.8 percent triplets or more.
In 2001 US ART, the chapter reports 6.72 embryos placed for every live birth, and an estimated average of 3.6 embryos transferred per cycle.

RRM Context

NaProTECHNOLOGY was developed by Dr. Thomas W. Hilgers, and this chapter appears in its textbook. Restorative reproductive medicine evaluates first and looks for the cause of infertility. ART bypasses the reproductive system without resolving why conception fails. Reporting outcomes for each woman over time would show how many couples have a live birth.

Our editorial summary of this paper, not the article's abstract.

Abstract

This chapter critically reviews artificial reproductive technology in the United States using the 2001 National Summary, faulting the national data set for not calculating pregnancy rates on a "per woman" basis and showing a sharp drop-out after the first treatment cycle. The chapter reports that 6.72 embryos were placed for every live birth and describes the multiple pregnancy, prematurity, ovarian hyperstimulation syndrome, selective reduction and prenatal diagnosis issues it associates with these procedures. Hilgers compares older "per woman" pregnancy rates after wedge resection for polycystic ovarian disease, conservative surgery for endometriosis and microsurgical salpingostomy with the per-cycle rates reported for IVF, and questions whether real progress has been made. The chapter closes by naming several "missing links" in modern reproductive medicine, first among them that most patients seeking evaluation for a reproductive abnormality do not receive an adequate diagnosis of their underlying disease.

Topics

Infertility › Evaluation › Diagnostic Workup · Restorative Reproductive Medicine › NaProTechnology › Protocols and Framework · Diagnostics › Cycle Biomarkers › Ovulation Detection

Thomas W Hilgers

Tom Hilgers, T Hilgers

Hilgers et al. 2004, Hilgers 2004

Chapter 38: Trends and Deficiencies in Infertility

Most infertility patients get no adequate diagnosis, a chapter argues

Key Findings

RRM Context

Abstract

Topics

By this author

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