Page 64 - ESHRE2019

Public funding of ART
Many problems with labelling infertility as a disease or medical problem:
- there is no ‘medical’ indication in many patients : ‘social’ infertility (lesbian couples, single women, postmenopausal women, ...)
- there are many definitions of ‘medical’: most people chose a definition that gives the wanted conclusion.
- if it is a disease, how do we determine the burden of disease? Calculate DALYs / QALYs? How many years does one suffer from infertility? Does ART cure your infertility?
- what to do with age-related infertility? Is age a disease?
Another option is to say that ART does something about the wish to have a child, not necessarily about infertility.
Public funding of ART
Different perspectives can be taken: becoming a parent (to reproduce) is a life plan.
Wanting to become a (genetic?) parent is a life plan just like wanting to become a philosopher or a doctor is a life plan.
Has society more reason to subsidize the first rather than the last?
How do we judge which life plan should have priority? Which criteria should be used?
- suffering as a consquence of the failure to realise the life plan?
- only when the majority believes this life plan is important?
Notice: infertility treatment in this perspective does not belong in healthcare.
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