Infertility in Argentina: An Illness?

Currently, around one in every six couple have infertility problems which lead to issues in getting pregnant. In Argentina infertility is not yet classified as an illness and therefore neither medical insurance nor state cover infertility treatments.

Last December the assisted human reproduction law was passed in the province of Buenos Aires, allowing couples with fertility problems can obtain a maximum of three fertility treatments a year. Now, debate is underway about the idea to introduce this law on a national level, with a possible bill being introduced to the national congress this year.

According to the World Health Organization, infertility is “an unmet need in family planning in both the developed and developing world”. Back in 1965, in the 18th World Health Assembly, the right to build a family was recognized to be a decision subject to each individual couple. In 2006 the UN General Assembly recommended achieving universal access to reproductive health as a target under the Millennium Development Goal 5: improve maternal health.

In Argentina, reproductive medicine is characterized by its excellence and cutting edge technologies, attracting couples from all over the world under the so-called “medical tourism”. One in six Argentine couples suffer from infertility, yet less than half of the affected population will be able to access medically assisted reproduction (MAR) treatments. And this situation is explained by the fact that infertility is not considered to be an illness.

With an Assisted Human Reproduction law recently approved in the province of Buenos Aires and with the prospects of a national regulation on the subject being discussed this year in congress, the subject of infertility has finally surfaced after 33 years of neglect and silence.

A medical standpoint

Dr. Sergio Pasqualini is a gynaecologist, obstetrician and a reproductive medicine specialist. He explains infertility as “the failure to achieve pregnancy after a year of sexual intercourse, during ovulation stages”. He adds “Infertile is a couple suffering from spontaneous abortions after getting pregnant. Sterile is a couple that cannot conceive. Today, these terms are often taken as synonyms.”

In respect of the above, it is important to emphasize the concept of couple. Both parties are considered to suffer from infertility, regardless of the actual illness’ origins – which are diverse. Therefore, what matters is to tackle the pathology suitably. And, most importantly, “when a woman comes to us seeking to get pregnant by means of a sperm bank it’s not an infertility case,” clarifies Dr. Pasqualini.

This illness may be caused by different factors and complications in conception can be attributed to both women and men alike. In fact, 40% of the infertility cases are originated in men, 40% in women and the rest, in difficulties from both parties. Hence, to achieve an accurate diagnose is important to analyse couples integrally. However, the most precise diagnosis is obtained by actually analysing gametes behaviour. Thus, many assisted fertilization techniques are therapeutic and diagnostic.

As far as the psychological factor is concerned, Dr. Pasqualini states it “presents itself as a cause or as a consequence of infertility. So it is important to work in parallel between the medical and the emotional management.”

Medically assisted reproduction can be accomplished by different assisted fertilization techniques. Nowadays, these are more commonly practised in women because its effectiveness is greater.

There are high complexity procedures and low complexity techniques to treat this illness. The first, imply the fertilization is carried out inside women’s bodies, while the latter imply extracorporeal fertilization such as In vitro fertilization. Both procedures –except for the programmed sexual intercourses- involve the taking of medicines to induce ovarian stimulation.

Finally, cryopreservation –the freezing or vitrification and storage of gametes, zygotes, embryos or gonadal tissue- has become a fundamental aid for patients. This procedure enables fertility preservation in risk population and, even if embryos or zygotes are vitrificated, it must not be related to induced abortions. “Nature is inefficient. It does a lot of discarding; but, the discarding is applied to the malformed or anything that proves incompatible with life. An embryo, if it is not meant to develop and live, it won’t. And this happens regardless of it being conceived in a laboratory or in a uterus,” clarifies Dr. Pasqualini.

A social and legal standpoint

Sumate a dar Vida is a civil partnership set up in 2008 by couples suffering from infertility. As Patricio Campos, media officer, Daniela Hornich, spokesperson, and Romina Cartoceti de Maldonado, secretary, explain, their main objective is to gather 300,000 signatures that, by means of a popular initiative, will force national congress to discuss an assisted human reproduction law in a national level.

“Back in 1995 there had been an assisted human reproduction bill in congress which did not prosper. It was very restrictive; we want a national law that does not prohibit any of the procedures used to treat infertility. Also, we want this law to cover all of the fertilization techniques,” clarifies Maldonado.

The assisted human reproduction law has two edges: techniques’ regulations and their coverage. Sumate a dar Vida, as a civil partnership composed by patients, is not meant to rule on regulations. They are mainly asking for infertility being recognized as an illness. The natural consequence would be that of its coverage.

But why should infertility be considered an illness in the first place? Because it affects directly three crucial aspects of every human being’s existence. Firstly, as described above, there is a physical impact: if the reproductive system cannot function properly it must be ill. Secondly, there is a psychological impact caused by anxiety or guilt feelings that test couple’s stability. Finally, there is a social impact that translates into ill couples choosing to isolate themselves from their friends or relatives. “It is hard when most of your friends have already two or three children. It is easier not to meet them. I, for example, went through that stage in which I did not want to go to birthday parties,” comments Hornich.

Also, there is an official pronouncement on the subject. Infertility “is an illness. The World Health Organization determined so, there is not much to discuss,” assures Campos.

Sumate a dar Vida has gathered 205,945 signatures after a three year’s work. And, considering last December’s fertilization law in the province of Buenos Aires, as well as last year’s debate in congress, there are high hopes a bill will also be discussed in 2011. “Last year, three bills were debated in the House of Representatives’ health committee. We still have to wait for debates in the childhood, women’s and adolescence committee, budget committee and federal legislation committee. If a bill is finally approved, then it would pass on to the Senate,” explains Maldonado.

As for the objections to a fertilization law, these are mostly addressed to cryoconservation procedures and are formulated by sectors related to religious ethics. They allege cryoconservation violates natural laws by vitrificating life. Truth is, echoing Dr. Pasqualini’s words, freezing potential embryos is not equal to freezing embryos. There is life, but there is not a baby: 15% of the natural pregnancies are spontaneously aborted; 20% in In vitro cases.

Cryoconservation helps preserve women’s bodies since, after a failed procedure, it prevents patients from taking more medicines and going through surgery again to extract more ovules.

Regarding budget, “we do not deny these techniques are expensive and that our health system is collapsed. The problem is that people commonly assume affected couples would need to be treated with high complexity procedures. In fact, out of the affected population, only 30% would require them. The rest can be treated with suitable medication or with low complexity procedures,” explains Maldonado.

Paradoxically, there are medical insurance plans that will provide customers with a free-of-charge plastic surgery a year. “I would not say it is discriminatory. The thing is, basic medical insurance plans do not include reproductive medicine specialists. And the amount of young couples with infertility problems is growing,” states Campos.

The law Sumate a dar Vida is trying to get debated in congress should be selective yet inclusive. Costs for infertility treatments vary from $3000 to $20,000 plus medicines. And, if a couple happens to come from a distant province, costs will ascend pending on their stay in Buenos Aires. Many patients are forced to indebt in order to cover treatments; others cannot even afford a consultation.

Finally, a law does not imply every couple has to go under infertility treatments. And it does not replace adoption; that is another issue different from infertility.

An experiential standpoint

Campos and Hornich have been married since 2004, and have been trying to get pregnant since 2006. Their case is complex, as both of them suffer from pathologies affecting their reproductive system. They have already gone through six high complexity procedures, “and the following, will be the last,” says Hornich. They are aware of the political and economical background a fertilization law has. Hornich, Campos and Sumate a dar Vida understand every medical institution will stand by its own interests, as will do the government.

When political will is the key factor to the improvement of citizens’ lives, organizations such as Sumate a dar Vida have a lead role in defending their rights. And conceiving is a right exclusively subject to couples’ decision. An assisted human reproduction law should not be discussed under the lens of a dogma, but bearing in mind present problems.

A law would ease infertile couple’s struggle to become parents and would at least relieve them from economical pressure. Though it is not an absolute solution to infertility, it signifies an extra help. For, as Hornich points out, “a law will not give me a child”.

To see what the Argentina public think about the new law, click here.