Across the globe, millions of people have difficulty conceiving. This is a significant global public health problem with many contributing factors, including societal attitudes toward fertility and reproductive rights, economics (e.g., high cost of treatment), and gender bias in access to care [1]. The need for creative solutions is clear; improving infertility services will have a huge impact on the lives of those who seek it.
An infertile hospital
In order to provide access to high-quality and equitable infertility care, a hospital-based clinic was developed and implemented by the NYU Reproductive Endocrinology and Infertility (REI) Fellowship program within Manhattan’s Bellevue Hospital Center (BHC). The REI clinic is run by residents and fellows and supervised by the REI faculty at BHC. The clinic is designed to meet the needs of infertile patients presenting to the hospital, with an emphasis on prevention, workup and treatment. The model has several unique features that are designed to address issues of equity, sustainability and quality.난임병원
The REI clinic at Bellevue is a half-day clinic that sees an average of 6-7 new and 3-4 follow-up patients per visit. The majority of clinic patients are women who have been trying to conceive for over six months, while others have an infertility diagnosis such as diminished ovarian reserve or tubal factor. Many of these patients are uninsured and unable to afford IVF.
To address these problems, the REI team has worked with community organizations to identify low-income patients who would benefit from infertility care and to provide referrals for the required testing. These patients are then seen by the REI residents and fellows during the course of their clinic rotations. In addition, the patients are provided with information for private centers throughout Manhattan that offer payment plans and mini-IVF to help them gain access to this care.
A major challenge is obtaining the necessary infertility workup, which can be very expensive. For example, a hysterosalpingography (HSG) and semen analysis are ordered for all patients with unexplained infertility and ovulatory dysfunction, but the cost of these tests is prohibitive for many patients. Consequently, patients are often referred to other Manhattan facilities for these tests, which takes months and increases their financial burden.
Increasing access to infertility care is complex because of the tension between offering limited or modified healthcare in places with nothing, versus the principle of justice, which states that “something is better than nothing.” In the US, the high cost of ART and a lack of coverage limit availability; 20 state health insurance plans now cover fertility preservation procedures, but only 14 of these include IVF and 12 require prior established care with an REI provider, which limits patient access even further.
There is also an opportunity for prevention of infertility, which can be achieved through education and counseling. Behavioral change such as dietary changes to promote weight loss can reduce insulin resistance/diabetes and increase fecundity, while avoiding pregnancy-inducing medications can decrease the risk of fetal anomalies and adverse maternal outcomes such as gestational diabetes and pre-eclampsia/eclampsia.서울아이앤여성의원