For many, conceiving a child is a special joy of life. For those who want to conceive but are unable, however, life can sometimes feel meaningless. Despite the emotional investment involved in reproduction and the millions who can't get pregnant or carry a baby to term, fertility is still a fairly untapped area of health care.

Duke University School of Nursing (DUSON) Assistant Professor Eleanor Stevenson, PhD, RN, and her colleague Patricia Hershberger, PhD, MSN, RN, FNP-BC, associate professor of nursing and an affiliate professor of medicine at the University of Illinois at Chicago, recently published a book entitled Fertility and Assisted Reproductive Technology (ART): Theory, Research, Policy and Practice for Health Care Practitioners.

“There are plenty of books available for physicians regarding infertility but not many for individuals in other fields of health care,” said Stevenson. “Our book is written for clinicians, public health officials, women’s health experts, scientists, students, scholars and other individuals who are interested in this area.”

The book, the first publication of its kind, includes a global focus from 26 multidisciplinary researchers, scholars and clinicians representing eight countries. It also features diverse contributions on contemporary health care perspectives regarding individuals and families dealing with infertility and fertility challenges, including advanced technologies such as in vitro fertilization (IVF), intrauterine insemination and oocyte preservation.

Infertility and the Challenges

According to the Centers for Disease Control and Prevention (CDC), more than 6.7 million women between the ages of 15 and 44 suffer from an impaired ability to get pregnant or carry a baby to term, and more than 7.4 million women have used infertility services.

“There is a higher rate of infertility than there is of diabetes, yet there is a challenge in where infertility fits into the health care system,” Stevenson said. “This even includes the fact that there aren’t many academic nurses with a focus in fertility.”

Stevenson, whose research focus includes the multidimensional psychological stress experienced by women who conceive using in vitro fertilization and the adaptive behaviors of men with male-factor infertility, was first exposed to this health care population as a doctoral student.

“My clinical career was focused on women’s health issues with my clinical practice being in high-risk labor and delivery, mother-baby, antepartum, and family planning” said Stevenson. “However, when I was a PhD student, I took a position at an infertility center that had a strong research focus. As I continued to work there, I became amazed at the unique needs and challenges of this patient population.”

Stevenson was so inspired by working with the patients at the infertility clinic that she changed her dissertation research. From that point on, Stevenson was in love with this population and their health care needs, and her research focus shifted to include infertility.

She has found that most people think that infertility is a social issue and not a health care issue. “A lot of people see parenthood as a ‘nice thing to have’ even though infertility has been defined as a disease process by large organizations such as the CDC and the World Health Organization,” she said.

The challenge of fitting infertility into the delivery of comprehensive health care is reflected in the fact that only 15 states within the United States have laws that require employers to cover or offer some level of infertility care as part of health care insurance. Other states, including North Carolina, allow companies to decide if they will provide insurance riders for their employees to receive some aspect of infertility care, meaning most people with insurance do not have infertility coverage.

These individuals, as well as those with government insurance or without insurance, are left to pay for very expensive treatment out of pocket, including assisted reproductive technologies (ART) such as in vitro fertilization. According to the RESOLVE: National Infertility Association, the cost of ART treatments can be up to $13,000 in the United States.

Stevenson states that approximately 50 percent of people diagnosed with infertility actually seek treatment. “In this country, individuals will either not get treatment because they can’t afford it or forgo buying their first home or putting money towards retirement for the chance to have a child. Not having insurance or being able to afford the treatment has social implications and is a reflection of class in the United States,” she said.

Infertility challenges aren’t just limited to access to care within the health care system. The ability to expand our knowledge of how best to care for this population is also a challenge. Nurse-led research is limited as well; Stevenson and Hershberger are only two of a few academic nurses in the country conducting research on fertility issues in order to improve care for this population.

Being able to make a dent in this area of health care, especially in the world of academia, will take more than 26 book chapters.

Stevenson stated that doing more research and obtaining more funding for research will make a difference. “Funding for research is always a challenge because there are only so many dollars available. However, because the common perception of the impact of fertility is so variable, it can be easier to obtain funding for research that involves other diseases such as diabetes than it is for fertility,” she said.

Stevenson also shared her desire to see more nurse scholars in the fertility area and to see this area of health care taught more. Accelerated Bachelor of Science in Nursing (ABSN) students at DUSON are taught the subject area by Stevenson, but she would love to see more nursing students exposed to this area of expertise across the board.

Infertility and the Global Perspective

Stevenson and Hershberger were adamant about having a global perspective with the book.

“Since the book is the first of its kind, we really wanted to be able to include aspects that would relate to anyone interested in infertility care regardless of where they were located,” said Stevenson. “In addition, it’s important to see how other countries are addressing infertility care.”

Stevenson shares how other countries have advanced in their infertility care. For instance, the United Kingdom includes infertility care for their insured as part of their National Health Services. Additionally, Europe leads the world in ART with more than 580,000 treatments a year compared to the U.S. with 150,000, according to the European Society of Human Reproduction and Embryology.

The authors were also able to learn other interesting things by having a global focus. For example, in the chapter entitled "Accommodating assisted reproductive technologies to rabbinic law" written by Tsipy Ivry, readers will learn about a procedure called kosher IVF. The chapter author discusses how women in Israel navigate the fertility process without compromising their religious connection.

The book also highlights global views on the timing of IVF and the ability to access care as well as the utilization of ART services in developed countries and the impact on cross-border reproductive care.

Although Stevenson and Hershberger are nurses, they want to assure readers this book isn’t just for nurses.  Stevenson said: “We’ve included invaluable information from thought leaders who are physicians, sociologists, psychologists, nurses and advocates. This book is meant for anybody who cares about people with infertility challenges.”

For more information on Fertility and Assisted Reproductive Technology (ART): Theory, Research, Policy and Practice for Health Care Practitioner or to purchase the book, click here.