Way forward

Fertility awareness

In our society, fertility awareness (FA) is deficient, since cultural and religious factors increase the prevalence of misconceptions and myths. Core factors encompass low education, persistent health-related issues, scarcity of resources for well-being, nonexistence of a developed public health system, and inadequate coverage by insurance policies. Contributing factors include poor access to fertility options, scarce knowledge about risk factors for infertility, and health warnings of postponing childbirth ( Fig. 13.1 ).

According to a study conducted in Pakistan, the reported prevalence of infertility is approximately 22% with 4% primary and 18% secondary infertility. The cultural and religious perspective about assisted reproductive technologies is also unclear, resulting in reduced acceptability.

Sufficient knowledge about infertility can urge young couples to seek timely medical care. We, therefore, recommend that infertile couples should be guided to approach the right person at the right time. Theinfertility clinics must have a list of relevant books and articles in local languages, audiovisuals, brochures, as well as the services of counselors who deals with fertility-related matters of individuals of different educational status. Additionally mass communication should play a very effective role to address misconceptions, myths, and religious taboos through health shows and discussion forums with popular celebrities/health ambassadors. Support of religious authorities should also be obtained through sensitization meetings, so as to research and clarify any misconceptions at different forums portraying the correct Islamic views on treatment options such as IVF, for better acceptability.

Role of healthcare professionals: First line of contact

In United Kingdom, Germany, and other developed countries, counseling of infertile couples and diagnostic evaluation come under the domain of primary care physicians. Counseling is offered at the time of first consultation and during the procedure by a person/specialist/psychologist who has a limited role in the management of the couple. According to the American Society for Reproductive Medicine (ASRM), these counseling techniques offered on case-to-case basis will enable the couples to face physical and emotional challenges of infertility and its treatment. Measures to improve general health through lifestyle modifications should also be included in this process. Comprehensive knowledge of the counselor and counseling skills can therefore decrease the perceived stress of subfertile couples and, therefore, improve treatment consequences. Once counseled and diagnosed properly, the couple can be offered the first line of treatment, failing which immediate referral is planned.

Unfortunately, a majority of subfertility patients belong to developing countries, where negative consequences of childlessness are more as compared to developed countries. Fertility awareness is minimal; cultural limitations, treatable recurrent infections, poor access to health facilities, and lack of appropriate counseling pose a serious threat to fertility. Access to newer technologies is rare, being costly and limited to big cities, making it unaffordable for a majority. Insignificant resources and low commitment of the government darken the scenario further. We postulate that the healthcare providers in primary care settings, being the first line of contact with the couple, can play a pivotal role to prevent infertility. Awareness and counseling sessions in the initial stages educate the patients about risk factors, which facilitate screening for and treating preventable causes, thus promoting patient compliance since “Beauty has no age; Fertility does.”

Counseling may be supported through print media (brochures) and where facilities exist, online modules and awareness workshops. If the couple does not conceive in a year’s time, the healthcare professional should proceed with prompt referral to infertility specialist.

Fertility in primary healthcare settings: Challenges and solutions

Infertility treatment in low socioeconomic countries is a stand-alone. Knowing the status of education and prevention in developing countries, efforts are required at national level to develop administrative guidelines, to incorporate infertility into primary-level reproductive healthcare programs. For the successful inclusion of infertility diagnosis in these circumstances, it is necessary that the knowledge and skills of healthcare workers should be updated through ongoing, regular training programs. Sufficient facilities should also be made available for routine investigations, since early identification of cause and prompt treatment can minimize complications of procedures. While the diagnosis and treatment of infertility are comparatively expensive, it is recommended that more advanced, operational, secure, and cost-effective ART strategies should be proposed by public and private sectors. A possible solution can be government’s initiatives to pledge low-cost IVF programs, supplemented with funding from international agencies and other resources. Agencies from the private sectors should also be invited to join hands to address awareness issues and mass communication to improve the quality of care for subfertility.