Editor's Note: This is the first in a two-article series from Dr. Pourhassani on infertility and acupuncture practice.Article #2 will appear in the December digital issue.
Is infertility a disease? Or is it a symptom, or condition of an underlying health condition, disease process, and/or iatrogenic in origin? Are we miseducating the public by referring to infertility as a disease in order to obtain insurance funding for expensive treatments?
In order to obtain payment from health insurance companies, infertility must be categorised as a disease associated with billable ICD codes. The World Health Organization defines infertility based on the ICD (International Classification of Diseases) as "a disease of the male or female reproductive system defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse."1 That is a very broad definition.
Dickey, et al., in an article titled, "Infertility Is a Symptom, Not a Disease,2 stated: "The facts are that infertility and its frequent companion, anovulation, are not diseases; they are symptoms of underlying, sometimes serious disease in one or both marital partners. "We are warned in this article of the potential of overlooking underlying health conditions for the immediate desire to obtain a pregnancy.
Surgeries and medication may also cause infertility. Potential iatrogenic causes of infertility include:
For insurance billing, in cases of post-vasectomy fertility,8 instead of using the sterilization code for the wife's visit, the American Society of Reproductive Society recommends using: N97.8 Female infertility, other specified origin (includes male factor); and Z31.81 Encounter for male factor infertility in female patients.
Most insurance companies do not include acupuncture coverage for infertility. We do not have insurance coverage for acupuncture as an adjunct to IVF, either. Adjunct acupuncture for IVF cycles is provided in order to retrieve more eggs, increase the thickness of the endometrial lining, increase live birth rates, and reduce miscarriages.
I am left with a few questions: When acupuncturists treat infertile men and women, are we not addressing underlying cause/s of infertility? Once a pregnancy is achieved in an infertile woman, is our work done? And what are repercussions of believing one has a disease, when it is really a symptom of an underlying condition which requires attention?
References
Chronic pain afflicts over 20% of the adult population. Sadly, most MDs have essentially no education in treating pain, beyond offering a few toxic medications. Then they tend to steer people with pain away from those health practitioners who are trained. This puts the acupuncture community on the front lines for addressing this epidemic.
When the body is going through a stressful event, the sympathetic system is activated. This activation will help the body with a life-threatening situation. If this state is activated for prolonged periods of time, it starts to consume energy. These traumatic events that generate stressors in the autonomic nervous system (ANS) will eventually become internalized.
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One of the things that makes acupuncture so difficult to measure is that the medicine actually does contain some esoteric aspects. There have been numerous studies that demonstrate the neurochemical reasoning behind why acupuncture points stimulate the autonomic nervous system to enact change However, not all the benefits of TCM can easily be measured by randomized, controlled trials. But does that make them fundamentally and definitively untrue?
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