Reproductive Dysfunction: A global definition for infertility for the 21 century
Eleuterio R. Hernández. Clínica "FivMadrid". Madrid, Spain.
Abstract. Infertility and sterility are frequently misunderstood by society and considered shameful by some of the affected. It is time to replace them with a new paradigm that better reflects the results of reproductive medicine. Reproductive dysfunction could be the alternative.
Reproduction is an essential function that allows living being to originate other beings like themselves of the same species.
Any being who is unable to reproduce has been defined as sterile; if a woman cannot carry a pregnancy to term she has been called infertile. The term sterility first appears in modern scientific literature in the seventeenth-century, for example, De Sterilitate Utriusque Sexus by Jean Huch, Observations diverses sur la Sterilite by Louise Bourgeois, and De Sterilitate by Martin Naboth (Morice et al., 1995; Mendiola et al., 2005). However, in recent times the term infertile has replaced sterile to define both situations and not just at the colloquial level (doctor-patient relationship) but also in scientific societies. For example the American Society of Fertility and Sterility became the Americas Society for Reproductive Medicine (ASRM) and the European Society (ESHRE) was born as the Society for the Study of Human Reproduction. Both societies have chosen a terminology more in keeping with the times that includes other aspects in our field of gynaecology and reproductive endocrinology.
Besides academic categories and other considerations, the fact is that today these two terms (infertility and sterility) are outdated, restrictive, poorly perceived by society (Williams, 2010) and shameful for the affected (Cousineau et al., 2007). In addition, they originated in a time in which to be sterile was final, that is, without any possibility of procreating, quite the contrary to what happens today, in which more than 70% of infertile couples have attained offspring through modern advances in reproductive medicine. Therefore, hasn’t the time come to replace these words with one that is more in line with the results of reproductive medicine and less pejorative for our patients?
Returning to the earlier definition of reproduction, “Reproduction is an essential function that allows living being to originate other beings like themselves of the same species." In my opinion it contains a word that could help identify an alternative for sterility/infertility: function.
To properly perform the function of reproduction one must be fertile and therefore any divergence from the correct functioning of reproduction we could call "reproduction dysfunction" or "infertility." This gives us two terms we can use to refer to our patients. One based on the source of the problem, which is the dysfunction, and the other on the outcome of the problem, which is infertility. In my opinion, the criteria to follow for choosing one (dysfunction) or the other (infertile) in daily practice should be based on the knowledge and results of reproductive medicine and less on the empiricism of the past.
Therefore, it would be more logical to say the patient has a reproductive dysfunction (idiopathic, ovarian, tubal, uterine, immune, etc.) instead of infertility, considering the emotional and pejorative connotation of the latter. A very good example of how the attitude and mood of patients may be affected by a term that is verbally and socially embarrassing is erectile dysfunction. In this case, the arrival of a revolutionary and decisive treatment (sildenafil, Viagra) was accompanied by a change in terminology ("impotence" to "dysfunction"), which raised the self-esteem of the patients, but also placed the condition on a more natural level for society, family and friends.
This convergence, between pathology and perception, has not happened with the arrival of Assisted Reproduction Techniques. IVF, a treatment that has totally revolutionized the outcome of infertility, has not been accompanied by substantial changes in the attitudes and perceptions by either the sufferers or that part of society that watches and judges them.
In conclusion, I hope that changing "infertility" to "reproductive dysfunction" in our minds and communications will promote the benevolent collusion between patient and society and our future patients will consult us for a reproductive dysfunction that has lead to infertility.
References
Cousineau TM, Domar AD. Psychological impact of infertility. Best Pract Res Clin Obstet Gynaecol. 2007; 21:293-308.
Morice P, Joset P, Chapron C, Dubuisson JB.: History of infertility. Hum Reproduction Update
1995; 1:497-504.
Mendiola J, Ten J, Vivero G, Roca M, Bernabeu R. Sterility and assisted reproduction: A history perspective Rev Iber Amer Infertil. 2005; 22:18-22.
Williams Z. Infertile? Then join the ranks of the undeserving ill. The Guardian, Thursday 9 December 2010
